2004 Oregon Physician Workforce Survey Report of Results · 2017-04-20 · 2004 Oregon Physician...

2004 Oregon Physician Workforce Survey Report of Results

Presented to

Oregon Department of Human Services,

Health Services, Office of Medical Assistance Programs Oregon Medical Association Office for Oregon Health Policy and Research March 7, 2005 Presented by

2020 SW Fourth Avenue, Suite 520 Portland, Oregon 97201-4960 Phone 503-279-0100 Fax 503-279-0190

2004 Oregon Physician Workforce Survey Report of Results March 7, 2005 Presented to • Oregon Department of Human Services, Health Services,

Office of Medical Assistance Programs • Oregon Medical Association • Office for Oregon Health Policy and Research

OMAP-EQRO-105570

2004 Oregon Physician Workforce Survey Executive Summary

Office of Medical Assistance Programs 3

Executive Summary Patient access to medical care in Oregon has been studied by multiple organizations in the past several years. To assist in the discussion, the Oregon Department of Human Services, Health Services, Office of Medical Assistance Programs (OMAP); the Oregon Medical Association (OMA); and the Office for Oregon Health Policy and Research (OHPR) joined forces to field a comprehensive physician workforce survey to gather valuable information on the current and future capacity of physicians in Oregon. This report is intended to present the data gathered from the 2004 Oregon Physician Workforce Survey and is one part of a large, ongoing effort to study and understand patient access to the physician workforce in the state. The focus of this report is to present data on physicians’ • changes to their practice • acceptance of insurance payer types • availability, especially of specialty care providers • concerns about professional medical liability insurance Data collection for the survey began in early September and continued through mid-October. Returned surveys were obtained from 3,508 physicians—a response rate of 34 percent. The highlights of results from the report are grouped by topic and listed below. Practice issues • Surgical specialty physicians (33 percent) reported more often that they planed to retire in the

next five years than did other specialty physicians. • Overhead costs, Medicare reimbursement, the cost and availability of liability insurance, and

Medicaid/OHP reimbursement were most frequently cited by respondents as very important issues.

• The most frequently cited changes to practice within next two years were increasing referral of complex cases, reducing patient care hours, increasing diagnostic procedures, stopping providing certain services, and stopping providing certain services to specific groups of patients.

• More physicians have been very satisfied with their medical career overall (50 percent) than have been satisfied within the last 12 months (34 percent).

Limiting acceptance of insurance payers • Of respondents, 73 percent accepted Medicare payers. Comparatively, 58 percent accepted all

Medicaid/OHP managed care and 59 percent Medicaid/OHP fee-for-service payers. Medicaid payers were the most restricted; that is, physicians limited acceptance or did not accept any patients with Medicaid/OHP insurance with the greatest frequency.

• The top reasons cited for limiting or not accepting any Medicare or Medicaid/OHP patients were: reimbursement, overhead costs, administrative requirements, and maintaining a balanced payer mix.

2004 Oregon Physician Workforce Survey Executive Summary


Specialty care • Of those who reported ever practicing maternity care, 42 percent (226) were delivering babies at

the time of the survey. • Of those who were currently delivering, 23 (10 percent) were planning to stop deliveries in the

next year; 14 planned to stop all deliveries, 9 planned to stop Medicaid deliveries. • Of the maternity care physicians who stopped deliveries, 76 percent stopped more than two

years ago. The top factors that influenced their decision to stop deliveries were medical liability premiums and time demands.

• Of the 22 neurosurgeons responding to the survey, 15 were currently perform brain and spine surgery, and 3 performed only spine surgery; 4 perform neither brain nor spine surgery.

Liability insurance • Physicians in surgical specialties reported higher premiums ($30,000 median annual premium)

than other specialties ($10,000 median annual premiums for primary care and medical specialty physicians).

• Obstetrics/gynecology physicians reported a median annual premium amount of $38,000 and neurosurgeons $54,000.

• Physicians reported most frequently that they have increased referrals (11 percent) or definitely planned to increase (12 percent) referrals of complex cases due to their concerns about liability insurance. Nine percent had already stopped providing certain services and four percent definitely anticipated doing so.

2004 Oregon Physician Workforce Survey Table of Contents


Table of Contents Executive Summary 3

Introduction 13

Background 13

Objectives and scope 15

Methodology 17

Study design 17

Survey development and administration 17

Data analysis 18

Results 21

Section 1. Respondent demographics 21

Section 2. Practice environment 25

Section 3. Acceptance of payers 39

Section 4. Specialty care 45

Section 5. Liability insurance 49

Further Research 55

Appendices

Appendix A. Data comparison and categorization tables A-1

Appendix B. Tab and banner crosstabulations B-1

Appendix C. Survey instrument C-1

2004 Oregon Physician Workforce Survey List of Tables and Figures


List of Tables and Figures Table 1-1. Racial distribution of survey respondents........................................................................... 23

Table 2-1. Primary practice settings reported by respondents ............................................................ 26

Table 2-2. Employment role distribution among respondents ............................................................. 27

Table 2-3. Length of licensure reported by respondents ..................................................................... 27

Table 2-4. Ownership or employment status of respondents .............................................................. 28

Table 2-5. Practice size distribution of respondents ............................................................................ 28

Table 2-6. Lead time to schedule non-urgent appointment reported by respondents......................... 29

Table 2-7. Number of patients seen in a typical week ......................................................................... 30

Table 2-8. Number of hours worked in a typical week......................................................................... 30

Table 2-9. Hours spent on administrative tasks each week ................................................................ 31

Table 2-10. Number of on-call hours each week .................................................................................. 32

Table 2-11. Greatest source of professional satisfaction...................................................................... 37

Table 3-1. Acceptance of payer types ................................................................................................ 39

Table 3-2. Comparison of restriction by payer type ............................................................................ 40

Table 4-1. Maternity care procedures performed by physicians practicing maternity care ................ 45

Table 4-2. Very important factors in decision to stop delivering babies, by ob/gyn and non-ob/gyn physician specialties....................................................................................... 47

Table 4-3. Characteristics of neurosurgeon respondents................................................................... 48

Table 5-1. Source, form, and amount of liability coverage ................................................................. 50

Table 5-2. Liability premium levels by specialty categories ................................................................ 51

Table A-1. Demographic characteristics for comparison between 2004 Oregon Physician Workforce Survey sample and Oregon Board of Medical Examiners 2004 census data.................... A-1

Table A-2. Oregon regions and counties within each region ............................................................... A-2

Table A-3. Unique physician specialties assigned to major specialty groups ..................................... A-3

Table B-1. Practice location by age of respondent .............................................................................. B-4

Table B-2. Practice location by physician specialty ............................................................................ B-5

Table B-3. Distribution of physician specialties.................................................................................... B-7



Table B-4. Practice setting by practice location................................................................................... B-9

Table B-5. Practice setting by physician specialty............................................................................... B-10

Table B-6. Practice setting by length of licensure................................................................................ B-11

Table B-7. Retirement plan by physician specialty .............................................................................. B-12

Table B-8. Age by plans to retire ......................................................................................................... B-13

Table B-9. Retirement plan by practice location ................................................................................. B-14

Table B-10. Physician specialty by length of licensure ......................................................................... B-15

Table B-11. Ownership or employment status by practice location....................................................... B-16

Table B-12. Ownership or employment status by physician specialty................................................... B-17

Table B-13. Ownership or employment status by length of licensure ................................................... B-18

Table B-14. Practice size by length of licensure.................................................................................... B-19

Table B-15. Practice size by practice location ....................................................................................... B-19

Table B-16. Practice size by physician specialty ................................................................................... B-20

Table B-17. Physician specialty by lead time to appointment for new patients ..................................... B-21

Table B-18. Lead time to appointment for established patients by physician specialty ........................ B-22

Table B-19. Lead time to appointment for new patients by practice location ........................................ B-23

Table B-20. Lead time to appointment for established patients by practice location............................. B-24

Table B-21. Patient caseload by length of licensure ............................................................................. B-25

Table B-22. Patient caseload by practice location ................................................................................ B-26

Table B-23. Patient caseload by physician specialty ............................................................................ B-27

Table B-24. Hours worked per week by gender..................................................................................... B-28

Table B-25. Hours worked per week by age.......................................................................................... B-28

Table B-26. Hours worked per week by practice location...................................................................... B-29

Table B-27. Hours worked per week by physician specialty.................................................................. B-30

Table B-28. Hours spent on administrative tasks by practice location .................................................. B-31

Table B-29. Hours spent on administrative tasks by physician specialty .............................................. B-32

Table B-30. Hours spent on administrative tasks by length of licensure ............................................... B-33



Table B-31. Hours spent on administrative tasks by gender ................................................................. B-33

Table B-32. Hours on call by length of licensure ................................................................................... B-34

Table B-33. Hours on call by practice location....................................................................................... B-35

Table B-34. Hours on call by physician specialty ................................................................................. B-36

Table B-35. Hours on call by urban or rural setting ............................................................................... B-36

Table B-36. Importance of issues by practice location .......................................................................... B-37

Table B-37. Importance of issues by physician specialty ..................................................................... B-48

Table B-38. Anticipated changes in upcoming two years by physician specialty ................................. B-59

Table B-39. Anticipated changes in upcoming two years by practice location ...................................... B-65

Table B-40. Satisfaction with medical career in past 12 months by physician specialty ...................... B-71

Table B-41. Satisfaction with medical career in past 12 months by length of licensure........................ B-72

Table B-42. Satisfaction with medical career in past 12 months by practice size ................................. B-73

Table B-43. Satisfaction with medical career in past 12 months by rural/urban.................................... B-73

Table B-44. Satisfaction with medical career in past 12 months by practice location ........................... B-74

Table B-45. Satisfaction with medical career in past 12 months by practice setting............................. B-75

Table B-46. Satisfaction with medical career in past 12 months by ownership or employment status ............................................................................................................. B-76

Table B-47. Satisfaction with medical career overall by physician specialty ......................................... B-77

Table B-48. Satisfaction with medical career overall by length of licensure.......................................... B-78

Table B-49. Satisfaction with medical career overall by practice size ................................................... B-79

Table B-50. Satisfaction with medical career overall by practice location ............................................. B-80

Table B-51. Satisfaction with medical career overall by urban/rural...................................................... B-81

Table B-52. Satisfaction within medical career overall by practice setting ............................................ B-81

Table B-53. Satisfaction with medical career overall by ownership or employment status ................... B-82

Table B-54. Greatest source of professional satisfaction by physician specialty .................................. B-83

Table B-55. Greatest source of professional satisfaction by practice location ...................................... B-84

Table B-56. Greatest source of professional satisfaction by length of licensure ................................... B-85

Table B-57. Greatest source of professional satisfaction by practice size ............................................ B-86



Table B-58. Greatest source of professional satisfaction by urban/rural............................................... B-86

Table B-59. Greatest source of professional satisfaction by practice setting ........................................ B-87

Table B-60. Greatest source of professional satisfaction by ownership of employment status ............ B-88

Table B-61. Acceptance of payer type by physician specialty............................................................... B-90

Table B-62. Acceptance of patients for each payer type by practice location ...................................... B-94

Table B-63. Distribution of physicians who currently deliver babies (N=226) ....................................... B-99

Table B-64. Maternity care procedures performed by practice location…………………………………B-100

Table B-65. Maternity care procedures performed by gender …………………………………………...B-102

Table B-66. Maternity care procedures performed by length of licensure………………………………B-103

Table B-67. Maternity care procedures performed by ob/gyn licensure…………………………………B-105

Table B-68. Distribution of physicians who are not currently delivering babies………………………...B-106

Table B-69. Time since stopping delivery of babies by ob/gyn licensure (N=303*)……………………B-107

Table B-70. Reasons for stopping delivery of babies by ob/gyn licensure………………………………B-108

Table B-71. Liability premium amount paid by ob/gyn licensure…………………………………………B-111

Table B-72. Liability premium amount paid by physician specialty………………………………………B-111

Table B-73. Liability premium amount paid by hospital status……………………………………………B-112

Table B-74. Liability premium amount paid by neurosurgery licensure………………………………….B-112

Table B-75. Liability premium amount paid by pediatric specialty licensure…………………………….B-113

Table B-76. Liability premium amount paid by high-risk specialty licensure ……………………………B-113

Table B-77. Actions regarding concerns about the cost or availability of liability insurance coverage…………………………………………………………………….B-114

Table B-78. Actions regarding liability by physician specialty…………………………………………….B-115

Table B-79. Actions regarding liability by physician licensure…………………………………………….B-118

Table B-80. Actions regarding liability by practice location……………………………………………….B-121

Figure 1-1. Flow chart of 2004 Oregon Physician Workforce Survey mailing and returned surveys ................................................................................................................. 21

Figure 1-2. Age distribution of survey respondents .............................................................................. 22

Figure 1-3. Regional distribution of respondents’ practice locations .................................................... 24



Figure 2-1. Specialty distribution of respondents.................................................................................. 25

Figure 2-2. Issues ranked by importance level ..................................................................................... 33

Figure 2-3. Anticipated changes to practice in the next two years ....................................................... 35

Figure 2-4. Respondents’ satisfaction with career overall and with career in past 12 months............. 36

Figure 3-1. Financial factors rated as very important in decision to limit or restrict patient payers ...... 41

Figure 3-2. Administrative factors rated as very important in decision to limit or restrict patient payers ..................................................................................................................... 42

Figure 3-3. Patient-related factors rated as very important in decision to limit or restrict patient payers ..................................................................................................................... 43

Figure 5-3. Possible practice changes regarding cost or availability of liability insurance coverage……………………………………………………………………………...52

2004 Oregon Physician Workforce Survey Introduction


Introduction Background

The 2004 Oregon Physician Workforce Survey was administered through the joint efforts of the Oregon Department of Human Services, Health Services, Office of Medical Assistance Programs (OMAP); the Oregon Medical Association (OMA); and the Office for Oregon Health Policy and Research (OHPR). These organizations came together in the interest of collaboration and efficiency in fielding one comprehensive survey to the Oregon physician community. OMAP was interested in surveying physicians about their practice behaviors with regard to Oregon Health Plan (OHP) enrollees; OMA had planned to field a follow-up survey to its 2003 Physician Workforce Assessment survey; OHPR joined the collaboration to gather data about healthcare providers in Oregon. Joining forces has resulted in valuable information on the current and future capacity of physicians in light of the challenges of providing medical care in Oregon. Many healthcare organizations have asserted that access to medical services in Oregon is an increasing problem.1,2,3,4 Medicare and Medicaid patients are having difficulty finding access to medical care. Physicians are leaving their practices and stopping the provision of certain services. These trends have been explained by many factors. Escalating costs of medical liability premiums have been linked to the exit from the state of specialty physicians who perform high-risk procedures and the cessation of certain high-risk procedures by these physicians.5,6 Unfavorable fiscal conditions, coupled with the inability of physicians to subsidize their public care with higher-paying private patients, have left publicly insured clients vulnerable. Additionally, physicians are increasingly limited in their ability to absorb losses due to higher practice overhead costs from increasing malpractice premiums and other cost drivers, such as reimbursement rates and administrative requirements.7 The results from the OMA 2003 Physician Workforce Assessment showed that about one-half of physicians limited acceptance of Medicare patients and more than 50 percent limited acceptance of Medicaid patients.8 The most frequently cited reasons for limiting access to Medicare and Medicaid patients were the cost or availability of liability insurance and the cost of doing business. According to a national survey of physicians conducted in 2002, the percentage of physicians accepting new fee-for-service Medicare patients fell significantly, by more than 6 percentage points, from 1999 to 1Physician workforce in Oregon 2004: a snapshot. [Oregon Health & Science University Center for Rural Health Web site]. Available at www.ohsu.edu/oregonruralhealth/workforcedata.htm. Accessed January 12, 2005. 2Campaign to bring medical insurance reform back to Oregon gaining momentum. [“Monday News Now” Web site of the Oregon Association of Hospitals and Health Systems]. August 9, 2004. Available at www.oahhs.org/publications/mondaynews/mn080904.htm#oahhs. Accessed January 12, 2005. 3Smits AK, Clark EC, Nichols M, Saultz, JW. Factors influencing cessation of pregnancy care in Oregon. Fam Med 2004;36(7):490–5. 4Oregon Medical Association. Preliminary report of the 2003 physician workforce assessment. Paper presented to the Oregon Medical Association House of Delegates, 129th Annual Meeting, April 26–27, 2003; Gleneden Beach, Oregon. 5Smits AK, Clark EC, Nichols M, Saultz, JW. Fam Med 2004;36(7):490–5. 6Oregon Medical Association. Preliminary report of the 2003 physician workforce assessment. Gleneden Beach, Oregon. 7Cunningham PJ. Mounting pressures: physicians serving Medicaid patients and the uninsured, 1997–2001. Tracking Report—Results from the Community Tracking Study No. 6. [Center for Studying Health System Change Web site]. December 2002. Available at www.hschange.com/CONTENT/505/505.pdf. Accessed January 12, 2005. 8Oregon Medical Association. Preliminary report of the 2003 physician workforce assessment. Gleneden Beach, Oregon.



2002. The number of physicians who accept either new fee-for-service or new managed care Medicaid patients during the same period declined by almost 9 percentage points.9 Although low reimbursement rates have been found to be the most significant barrier to physician participation in Medicare and Medicaid, higher reimbursement rates are no longer sufficient to maintain participation in Medicaid. Some of the other barriers include the higher economic costs of providing care to Medicaid patients than to other patients, the social complexity of Medicaid patients compared with other patients, the difficulty of coordinating specialty care and tests for Medicaid patients, the relatively higher medical complexity of Medicaid patients compared with other patients, and the cumbersome administrative processes associated with Medicaid compared with other insurance payers. The medical community has asserted that physicians are retiring, leaving the state to practice elsewhere, and ceasing to offer high-risk procedures and specialties. 10,11 The specialties most often mentioned as in danger of losing physicians include obstetrics/gynecology and neurosurgery. A recent Oregon Health & Science University (OHSU) study on obstetrics care in Oregon found that more than one-half of physicians and midwives performing deliveries in the state have either stopped or plan to stop this care. Patients in rural areas and those insured by Medicaid are disproportionately affected by this trend.12 The major reasons cited for stopping the delivery of babies were high professional medical liability premiums and low reimbursement rates. Neurology is another specialty often cited as on the decline. The 2003 OMA Physician Workforce Assessment showed that 4 percent of neurosurgeons had stopped providing all care whereas 30 percent indicated that they had stopped providing certain services. The OMA has attributed the exit of neurosurgeons and cessation of specific services to mounting liability premiums.

9Schoenman JA, Feldman JJ. 2002 survey of physicians about the Medicare program: results of the Medicare Payment Advisory Commission’s 2002 survey of physicians. March 2003: No. 03-01. [Medicare Payment Advisory Commission (MedPAC) Web site]. Available at: www.medpac.gov/publications/contractor_reports/Mar03_02PhysSurvRpt2.pdf. Accessed January 12, 2005. 10High-risk specialties have higher rates of lawsuits than other specialties. Grover S. Medical malpractice damage caps: impacts of limiting noneconomic damages. July 29, 2004. [Oregon Medical Association Web site]. Available at: www.theoma.org/Files/ECON_NW_MEDMAL_REPORT.pdf. Accessed January 14, 2005. 11Oregon Medical Association. Preliminary report of the 2003 physician workforce assessment. Paper presented to the Oregon Medical Association House of Delegates, 129th Annual Meeting, April 26–27, 2003; Gleneden Beach, Oregon. 12Smits AK, Clark EC, Nichols M, Saultz, JW. Fam Med 2004;36(7):490–5.



Objectives and scope

The objectives of this report are to synthesize data from the 2004 Oregon Physician Workforce Survey into findings that will • provide reliable data on the current capacity of Oregon’s medical community to deliver health

care to Oregon healthcare consumers as well as forecast the future capacity of the state’s physicians

• identify barriers to physician participation in OHP, in addition to reimbursement • assess the effects of professional liability insurance costs on access to care The data identify the characteristics of physicians who do and do not participate in

o OHP/Medicaid o Medicare o other lines of insurance o treating the uninsured

This report is intended to present the data gathered from the 2004 Oregon Physician Workforce Survey. These findings are one part of a joint effort to study and understand patient access to the physician workforce in the state. Project stakeholders will formulate conclusions and recommendations for healthcare policies and programs in Oregon.

2004 Oregon Physician Workforce Survey Methodology


Methodology Study design This survey used a cross-sectional study design to assess the current capacity of Oregon’s medical community. Cross-sectional surveys are used to gather information on a population at a single point in time. Data obtained from descriptive cross-sectional studies are useful for planning and resource allocation. The 2004 Oregon Physician Workforce Survey data were collected using a questionnaire that utilizes both qualitative (e.g., open-ended) and quantitative (e.g., forced-choice) questions. One of the goals of the survey is to provide a comprehensive picture of the current landscape of the Oregon medical community. Therefore, the survey was administered to all physicians who provide direct patient care in Oregon and to those who have administrative roles. The source of the sampling frame was the May 2004 version of the OMA census database, which is based in part on the Oregon Board of Medical Examiners (BME) census database and includes both OMA members and nonmembers. To meet the eligibility criteria, physicians were to have an active license in Oregon and either reside in, or have a practice listed in, Oregon.13 It is estimated that about 1,000 physicians hold Oregon practice licenses but practice elsewhere, including in the neighboring states of Washington, Idaho, and California. The survey allowed these physicians to identify themselves. Physicians deemed ineligible include medical students, retired, inactive, or deceased physicians. For the purposes of the survey, 10,354 physicians meet these criteria. Survey development and administration The OMA 2003 Physician Workforce Assessment survey was used as basis for the 2004 Oregon Physician Workforce Survey. The survey was developed by the OMA, OMAP, and OHPR and finalized after one round of cognitive testing. The cognitive testing involved a group of nine physicians, including specialists and rural practitioners. All physicians who agreed to participate in the cognitive testing provided their feedback during telephone interviews. Pretest subjects were asked to evaluate question content and questions with the potential for misinterpretation. In addition to the cognitive testing, internal pretesting with staff physicians was completed to identify questionnaire problems. The internal quality control process was completed with a focus on skip patterns and formatting issues. The survey was administered as a paper survey delivered by mail. The mail component involved a four-wave protocol, which consisted of a prenotification postcard, an initial questionnaire with cover letter and reply envelope, a reminder postcard, and a second questionnaire, cover letter and reply envelope to nonrespondents. All pieces were sent by first-class mail. An initial postcard was sent on August 15, 2004, to all physicians notifying them of the upcoming survey. On August 20, 2004, the first round of surveys was sent to 10,354 eligible physicians. Responses were tracked with a printed unique identifier on the reply envelope, to maintain respondents’ anonymity. Approximately 150 surveys were returned for invalid addresses. These were tracked and addresses were updated as available to target for the second round of mailing. A reminder postcard was mailed to all physicians on September 1, 2004. The second round of surveys was sent to 8,560 nonrespondents on September 10, 2004. Approximately 73 percent of the 3,508 returned surveys were received from the first mailing.

13An active license is one that is listed as unrestricted, limited, public order on file, or prior action.



Returned surveys were processed and tracked in a database by the unique identifiers printed on the back of each reply envelope. Surveys not returned in the provided reply envelope were inspected individually by the OMPRO project manager for inclusion. If a duplicate survey was returned, it was not entered. Once the surveys were tracked and entered into a database, they were sent to data entry. The data entry person hand-entered the responses into a response database that was created with rigorous validation codes for logic and skip patterns. Initially, the lead analyst and project manager monitored data entry on a daily basis to check for entry errors and monitored the validation log for entries that failed the validation. Survey responses were entered until October 13, 2004. In order to ensure the integrity of the data used for analysis of the survey, several steps were taken to check the accuracy and completeness of the data that were entered. The validation process had two parts: • ensure that data were entered accurately by data entry staff • ensure that entered data were complete and valid Validation rules were created in the data entry database to check the validity of entered data. These validation checks determined whether data elements were missing (i.e., not entered) or fell within valid parameters. Most of the validation occurred at the time of data entry. Data analysis Descriptive and inferential statistics were used to analyze survey data, employing the Statistical Program for the Social Sciences (SPSS) software version 10.0. Frequencies and chi-square tests for n-independent samples were used to evaluate statistically significant differences among subgroups. Statistically significant variation was detected in physician response to certain survey questions. Discussion is provided in the Results section for noteworthy differences. For Sections 1–5, crosstabulations are provided in Appendix B with Pearson chi-square test statistics and p-values. Variables that are consistently used in the report are coded as follows: Physician specialties, self-designated by respondents, were grouped into five categories as defined by OMA: • primary care • medical specialties • surgical specialties • hospital-based • other14 Practice locations were categorized into seven geographical regions based on the ZIP codes provided by respondents: • Portland metropolitan area • mid-Willamette valley • northwestern Oregon • southern Oregon 14 Responses that fell into the "other" physician specialty category included primarily psychiatry and occupational medicine.



• eastern Oregon • southwestern Oregon • central Oregon Each region is made up of two or more Oregon counties. See Appendix A, Table A-2 for the distribution of counties within each region. Maternity care is defined as the delivery of babies, for the purposes of this analysis. Physicians were deemed maternity care providers if • they indicated that they currently perform deliveries

or • they indicated that they do not currently perform deliveries, but they also indicated when they

stopped delivering babies15 Data limitations Self-reported data may be subject to error for several reasons. Retrospective self-reported responses are vulnerable to memory bias; that is, events that occurred a long time ago or the frequency of certain behaviors may be difficult to recall by respondents. Also, respondents may not have complete information to provide accurate responses. For instance, this survey asked physicians to respond to questions related to their medical practice’s acceptance of patient groups by payer types. Physicians employed by a healthcare system may not be aware whether the system restricts access to specific groups of patients (e.g., Medicaid patients). Several factors affect the response rate achieved by a given survey, including the length and timing of the field period, the mode of interviewing, the interest of the survey content to respondents, incentives, and the total level of resources available to follow up with difficult-to-reach respondents. Despite the number of attempts to contact physicians, a substantial percentage of the surveys (66 percent) were not returned. Survey nonresponse often biases survey results because it makes the results less generalizable to the population. Gender, region, and age distributions in the survey sample were compared to census data of the Oregon physician population recorded by the Oregon Board of Medical Examiners (BME) for 2003. The comparison did not reveal any large differences between survey respondents and Oregon physicians in the BME census data. Appendix A, Table A-1 shows the comparison of demographic characteristics for the Oregon Board of Medical Examiners 2003 census data and the 2004 Oregon Physician Workforce Survey sample.

15Four obstetrics/gynecology physicians indicated that they do not currently deliver babies but did not answer the corresponding skip pattern questions about cessation of deliveries. They were included as maternity care providers.

2004 Oregon Physician Workforce Survey Results


Results Section 1. Respondent demographics Of the 10,354 Oregon physicians who received the survey, 34 percent (3,508) returned a complete or partially completed survey. Of the returned surveys, 666 were completed by physicians who indicated that they do not provide any patient care or have an administrative role in Oregon; 320 were incomplete or unusable.16,17 Surveys were considered complete if more than 60 percent of the “core” questions applicable to all respondents were answered.18 The final analytic file included 2,522 usable surveys.19 See Figure 1-1 for a flow chart accounting for all surveys mailed. Figure 1-1. Flow chart of 2004 Oregon Physician Workforce Survey mailing and returned surveys The respondents were largely representative of all physicians in the state according to their age distribution, gender, and practice location, with the exception of physicians in the Portland metropolitan region who were slightly underrepresented by survey respondents. Respondents were

16Physicians indicated their ineligibility in one of two ways: by checking a box in the instructions section of the survey that his or her professional time does not involve any direct patient care or administration, or by responding in survey question 8 that he or she is fully retired, or not practicing or not employed in a medical field. 17Surveys were deemed unusable if they were returned with illegible identifiers, missing pages, or no responses (completely blank surveys). 18Core questions include 12–15, 17–18, 20–21, 24, 27, 29–36, 39–40, 45–47, 50. Questions intended for specialty physicians only and questions that are part of skip patterns are not included in the core set. 19To maximize the number of complete surveys in the final analytic file, the 60 percent “rule” for completeness was used. Of the potentially usable surveys, 90 percent of respondents (2,535) completed 60 percent of the survey.

10,354 surveys mailed to Oregon physicians

3,508 surveys returned6,846 surveys not returned

666 surveys returned byphysicians providing

neither direct patient care nor administration

320 incomplete orunusable surveys

2,522 completedsurveys for analysis



predominantly white males between the ages of 40 and 59 and practiced in urban areas, either in the Portland metropolitan region or in the mid-Willamette valley.20 Age and gender Figure 1-2 shows the distribution of ages of survey respondents.21

Figure 1-2. Age distribution of survey respondents Of the 2,522 surveys used for analysis, 72 percent were completed by males; 28 percent by females.22 Race and ethnicity Physicians reported that they belong to at least one of six race categories. Table 1-1 on the next page shows the distribution of responses.

20For more information on the classification of regions as urban, see Section 2, Hours spent on administrative tasks, page 25. 21The age distribution of physicians responding to the 2004 Physician Workforce Survey was similar to the overall age distribution of physicians in Oregon, according to the 2003 physician census kept by the Oregon Board of Medical Examiners (BME). 22The gender distribution of physicians responding to the 2004 Physician Workforce Survey was similar to the overall gender distribution of physicians in Oregon, according to the 2003 physician census kept by the Oregon BME.

70 years and over3%

60-69 years14%

50-59 years33%

40-49 years29%

Under 40 years21%



Table 1-1. Racial distribution of survey respondents

Racea Percent

White 90

Asian 6

Other 2

American Indian or Alaskan Native 1

Black or African American 1

Native Hawaiian or Pacific Islander 0 aCategories are not mutually exclusive. Two percent of the respondents (52 physicians) reported their ethnicity as Hispanic or Latino. Language proficiency Respondents reported on the languages in addition to English in which they could communicate effectively for most clinical purposes. Spanish was the language most often named; 17 percent reported that they communicate effectively in this language. Russian, Vietnamese, and other languages were reported by 11 percent of the respondents. Fifteen physicians reported that they can communicate for clinical purposes in Russian; four mentioned using Vietnamese to communicate, and 261 named French, German, or other languages. Practice location Nearly three-quarters (72 percent) of physicians reported the ZIP code in which their primary practice is located. Practice locations were categorized into seven geographical regions. Each region is made up of two or more Oregon counties. Figure 1-3 shows the distribution of respondents’ practices by region.23 For the list of regions and counties within each region, see Appendix A, Table A-2. .

23The regional distribution of physicians responding to the 2004 Physician Workforce Survey was similar to the overall regional distribution of physicians in Oregon, according to the 2003 physician census figures of the Oregon BME.



Southwestern2%

Eastern4%

Southern11%

Northwestern3%

Mid-Willamette Valley23%

Central9%

Portland Metro48%

Figure 1-3. Regional distribution of respondents’ practice locations See Appendix B, Tables B-1 and B-2 for a crosstabulation of practice location by age of respondent and physician specialty.



Medical specialties21%

Surgical specialties11%

Hospital-based16%Other

8%

Primary care44%

Section 2. Practice environment

Respondents provided information on their practice environment, including the physician specialty, retirement plans, employment role, ownership status, length of licensure, practice size, lead times for patient appointments, workload, important issues, anticipated changes, and satisfaction with their career. Physician specialty Nearly all of the respondents that completed the survey reported their specialty (2,506). The responses were combined into five specialty categories used by OMA in the 2003 Physician Workforce Assessment. A brief description of the category and major specialty types follows: • Primary care includes internal medicine, family practice, pediatrics, and obstetrics/gynecology. • Medical specialties include internal medicine specialties, ophthalmology, and urology. • Surgical specialties include general surgery and surgical specialties, such as orthopedics and

neurosurgery. • Hospital-based specialties include anesthesiology, emergency medicine, pathology, and

radiology. • Other specialties include psychiatry and occupational medicine.

Figure 2-1 shows the distribution of the five major specialty categories among survey respondents.

Figure 2-1. Specialty distribution of respondents

For a full list of the 60 reported physician specialties and the number and percent of respondents reporting each specialty, see Appendix B, Table B-3.



A small percentage of respondents reported having a pediatric focus within their specialty: 5 percent of respondents in medical specialties and 3 percent of those in surgical specialties said that their practice included pediatrics.24 Among the respondents that reported hospital-based specialties, 36 percent are emergency medicine physicians. Practice setting The majority of physicians reported that their primary practice setting is in a private, for-profit clinic or a hospital.25 Table 2-1 shows the distribution of practice settings reported by respondents.

Table 2-1. Primary practice settings reported by respondents

Practice settinga Percent

Clinic, private, for-profit 54

Hospital 43

Clinic, private, not-for-profit 12

Clinic, public 5

Other 4 aCategories are not mutually exclusive. See Appendix B, Tables B-4 through B-6 for a crosstabulation of practice setting by respondents’ practice location, physician specialty, and length of licensure. Retirement plans More than three-quarters of the respondents (78 percent) reported that they plan to retire more than five years from now; 22 percent said they plan to retire some time in the next five years. There is statistically significant variation by age in reported retirement plans. As expected, older physicians reported plans to retire sooner than younger physicians. The majority of physicians 60 to 69 years old (74 percent) plan to retire in the next five years, as do 73 percent of physicians 70 years and older. There also appears to be significant difference by specialty, with a higher percentage of physicians in surgical specialties reporting plans to retire in the next five years (33 percent) than those in other specialties. For a crosstabulation of retirement plans by physician specialty, age, and practice location, see Appendix B, Tables B-7 through B-9. Employment role All of the respondents who practice or have administrative roles reported that they have one or more employment roles. Physicians who were fully retired—neither practicing clinically nor

24The survey did not specifically ask physicians to state whether their specialty included pediatrics. The number of respondents who did not mention pediatrics, but do, in fact, see children in their practice, is unknown. 25The survey instructs respondents to consider the location at which they spend the greatest amount of time in direct patient care as the primary practice location.



employed in an administrative role—did not complete the survey. Table 2-2 shows the distribution of employment roles among respondents.

Table 2-2. Employment role distribution among respondents

Employment rolea Percent

Clinical practice 96

Teaching 19

Administration 12

Research 9

Resident/fellow 2

Semi-retired 0b aCategories are not mutually exclusive. bSemi-retired physicians that completed the survey were less than 1 percent of all respondents (9 respondents). Length of licensure The majority of physicians who responded to the survey (89 percent) reported that they have had a medical license in any state, including Oregon, for six or more years. Table 2-3 shows the distribution of respondents’ length of licensure.

Table 2-3. Length of licensure reported by respondents

Length of licensure Percent

Less than 2 years 2

2–5 years 9

6–10 years 15

11–20 years 29

More than 20 years 45 See Appendix B, Table B-10 for a crosstabulation of physician specialties by length of licensure. Ownership or employment status Physicians reported on their ownership or employment status at their primary practice site. Table 2-4 on the next page shows the distribution of responses.



Table 2-4. Ownership or employment status of respondents

Ownership or employment status Percenta

Full or part owner of practice 55

Employee of practice or health system 35

Independent contractor 7

Other 2

Volunteer 1

aPercents do not add to 100 percent due to rounding.

For respondent ownership or employment status by practice location, physician specialty, and the length of licensure, see Appendix B, Tables B-11 through B-13. Practice size Roughly one-third of respondents (35 percent) reported that they practice in a large group practice (10 or more physicians). Table 2-5 shows that physicians who work in solo, small, and medium group practices are approximately evenly distributed.

Table 2-5. Practice size distribution of respondents

Practice size Percent

Large group practice (10 or more physicians) 35

Solo practice (1 physician) 24

Small group practice (2–4 physicians) 22

Medium group practice (5–9 physicians) 20

There is significant variation in respondents’ primary practice size by practice location, physician specialty, and length of licensure. Medium-sized practices have higher percentages of physicians licensed for less than 10 years than other practice size categories. More than one-half of solo practice physicians have been licensed for more than 20 years. The majority of large group practices report a Portland metropolitan or Mid-Willamette Valley practice location (83 percent). Surgical specialty physicians comprise 18 percent of solo practices, which is proportionally greater than their representation in other practice sizes (Χ2=243.582, p<0.0001). Appendix B, Tables B-14 through B-16 show the crosstabulations of practice size by length of licensure, practice location, and physician specialty. Lead time for scheduling a non-urgent appointment Respondents reported a wide range for the number of days required for new patients to schedule a non-urgent appointment. Reported lead times for appointments were combined into four roughly equivalent categories. Although the average lead time for a new patient appointment is 17 days,



Table 2-6 shows that nearly one-half (45 percent) see new patients within 7 days.26 The majority of respondents reported seeing established patients within 7 days (66 percent); the average lead time for an appointment for established patients is 9 days.27

Table 2-6. Lead time to schedule non-urgent appointment reported by respondents Days to schedule a non-urgent appointment by patient type Percenta

New patients

0–7 days 45

8–14 days 22

15–30 days 21

More than 30 days 12

Established patients

0–7 days 66

8–14 days 19

15–30 days 13

More than 30 days 3

aPercents do not add to 100 percent due to rounding. Primary care physicians reported seeing new patient within 7 days more frequently than specialty physicians. More than one-half of primary care physicians (54 percent) reported that, on average, new patients were seen within seven days of making an appointment. New-patient appointments within seven days of scheduling were reported by 31 percent of medical specialty physicians and 43 percent of surgical specialty physicians. For established patients, 76 percent of primary care physicians reported an average lead time within seven days, compared with 48 percent of medical specialty physicians and 59 percent of surgical specialty physicians. For a crosstabulation of lead times for appointments for new and established patients by physician specialty and practice location, see Appendix B, Tables B-17 through B-20. Caseload Total caseload categories were determined by examining the distribution of reported numbers of new and established patients seen in a typical week. Caseload levels were rolled up into five categories and a sixth category of zero patients for respondents who do not routinely have a fixed panel of patients.28 See Table 2-7 for the distribution of the number of patients seen in a typical week.

26A total of 1,806 respondents reported lead time for an appointment for new patients: the minimum reported lead time for an appointment for new patients was 0 days; maximum, 365; the standard deviation is 24 days. 27A total of 1,791 respondents reported lead time for an appointment for established patients: the minimum reported lead time for an appointment for established patients is 0 days; maximum, 365; the standard deviation is 16 days. 28A total of 2,522 respondents reported the number of new and established patients seen in a typical week. The minimum reported number of patients was 0 patients; maximum, 800; the standard deviation is 47 days.



Table 2-7. Number of patients seen in a typical week

Number of patients seen in a week Percenta

0 patients 15

1–25 patients 17

26–50 patients 19

51–75 patients 19

76–100 patients 19

More than 100 patients 12

aPercents do not add to 100 percent due to rounding. Differences in caseload were detected by practice location, specialty, and length of licensure. Physicians with practices outside the Portland metropolitan region reported seeing more than 100 patients in a typical week more often than physicians in the Portland metropolitan region. As might be expected, primary care physicians reported heavier patient caseloads than physicians in other specialties. Primary care physicians more often reported seeing 76 or more patients in a typical week (47 percent). See Appendix B, Tables B-21 through B-23 for crosstabulations of patient caseload by length of licensure, practice location, and physician specialty.

Number of hours worked The number of hours a respondent worked was determined by adding the number of hours per week in direct patient care across primary and secondary practice locations.29 If a respondent reported specialties in addition to a primary specialty, these hours were included. Respondents reported a wide range for the number of hours worked each week; the average number of hours worked in a typical week was 44.30 Most respondents work full time or more than full time in a typical week. Table 2-8 shows that two-thirds (66 percent) of respondents work 40 or more hours each week.

Table 2-8. Number of hours worked in a typical week

Number of hours worked each week Percent

Less than 20 hours per week 11

20–39 hours per week 23

40–60 hours per week 41

More than 60 hours per week 25

29Work hours were defined to include time spent on patient record keeping, patient-related office work, and travel time connected with seeing patients. Training, teaching, research time, hours on call when not actually working, and travel between home and work were not included. 30A total of 2,520 respondents reported number of hours per week. The minimum reported average number of hours worked per week was 0; maximum, 160; the standard deviation is 21. Two physicians reported working more than 168 hours in a week, which exceeds the possible number of hours in a week.



Significant differences were found in the number of hours worked in a typical week by gender, location of practice, physician specialty, and age. Female physicians (45 percent) reported working fewer than 40 hours a week more often than male physicians (30 percent). Physicians practicing outside of urban areas reported work weeks of greater than 60 hours more frequently than physicians practicing within urban areas.31 Physicians in surgical specialties reported working more than 60 hours a week (46 percent) more often than physicians in other specialties. Physicians older than 60 years of age reported working fewer hours each week than their younger counterparts. See Appendix B, Tables B-24 through B-27 for a crosstabulation of hours worked each week by gender, age, practice location, and physician specialty.

Hours spent on administrative tasks Physicians reported on the number of weekly hours spent on administrative tasks related to direct inpatient and outpatient care: for example, charting, phone calls, referrals, and paperwork. Physicians spent, on average, 10 hours a week on administrative tasks.32 Table 2-9 shows the distribution of responses.

Table 2-9. Hours spent on administrative tasks each week

Hours spent on administrative tasks each week Percent

Less than 5 hours 20

5–9 hours 29

10–14 hours 28

15–19 hours 10

20 or more hours 13

Significant differences were found in the amount of time spent in administrative tasks by location of practice, physician specialty, and length of licensure. Physicians in southern Oregon more often reported spending more than 20 hours a week on administrative tasks (21 percent) than physicians in other areas of the state. Likewise, physicians likely to have a fixed patient panel—e.g., those in primary care, medical specialties, and surgical specialties—reported spending more hours performing administrative tasks than physicians in hospital-based and other specialties. Appendix B, Tables B-28 through B-31, show the number of hours spent on administrative tasks by practice location, physician specialty, length of licensure, and gender.

31This analysis uses the definition of urban and rural areas created by the Office of Rural Health at Oregon Health & Sciences University: rural areas are “all geographic areas 10 or more miles from the centroid of a population center of 30,000 or more.” More information is available at the Office of Rural Health Web site: www.ohsu.edu/oregonruralhealth/urbanruralcheck.pdf. 32A total of 2,456 respondents reported the number of hours per week they spend on administrative tasks. The minimum reported average number of hours worked was 0; maximum, 80; the standard deviation is 7 hours. Seven physicians reported spending more than 40 hours a week on administrative tasks.



On-call hours Physicians reported on the number of hours they spend on call in a typical week. Table 2-10 shows that almost one-quarter of physicians report more than 30 hours of on-call time each week.

Table 2-10. Number of on-call hours each week

Hours each week respondent is on call Percenta

Never on call 19

1–10 hours 12

11–20 hours 14

21–30 hours 18

More than 30 hours 24

Always on call 12

aPercents do not add to 100 percent due to rounding. The number of on-call hours reported varies by physician specialty, length of licensure, and practice location. For example, 50 percent of physicians in rural areas of the state reported being on call more than 30 hours a week compared with 33 percent of physicians in urban areas reporting being on call for more than 30 hours each week. Physicians in surgical specialties reported spending more than 30 hours a week on call more often than physicians in other specialties. Appendix B, Tables B-32 through B-35 show crosstabulations of on-call hours by length of licensure, practice location, physician specialty, and urban/rural region designation.

Issues important to respondents Physicians rated the importance of 21 current issues in health care. Financial issues such as overhead cost, Medicare reimbursement, the cost or availability of liability insurance, and Medicaid reimbursement were the top issues rated as “very important” by roughly two-thirds of respondents or more. Figure 2-2 shows all issues ranked by importance.



121618

252625

384144454547

525458606162666970

3940

4945

5545

4535

4238

4334

3737333232

272620

23

4944

3330

1830

1824

1417

1219

119987

108

117

0 20 40 60 80 100

Cost of translation servicesElectronic prescribing

Providing culturally appropriate servicesMedicare prescription drug benefit

Hospital/medical staff issuesRecruitment of physicians

Recruitment of qualified non-physician staffElectronic medical records

Timeliness of health plan paymentRetention of physiciansGovernment regulation

Call coveragePharmaceutical costs

Coverage for uninsuredStress and burnout

Commercial insurance reimbursementPatient safety

Medicaid/OHP reimbursementCost/availability of liability insurance

Medicare reimbursementOverhead cost

Percentage of respondents rating issue at importance levela

Very Important Somewhat Important Not Important Figure 2-2. Issues ranked by importance level

aBar percentages may not add to 100 percent due to rounding.



For crosstabulations of physicians’ importance ratings on current healthcare issues by practice location and physician specialty, see Appendix B, Tables B-36 and B-37. Anticipated changes to practice in the next two years Physicians reported on the changes they anticipate making to their practice in the next two years with regard to providing services, accepting patients, and planning for their business in the upcoming two years. Figure 2-3 shows the changes that respondents have considered making within the next two years. Increasing referral of complex cases is the change that respondents most often reported they are likely to make; 12 percent of respondents reported they “definitely will” make this change. For crosstabulations of anticipated changes to practice by specialty and practice location, see Appendix B, Tables B-38 and B-39.



2

3

3

4

4

4

7

7

7

8

12

13

10

9

7

9

13

22

14

19

23

22

85

88

88

89

87

83

71

79

73

70

66

0 20 40 60 80 100

Relocate practice to another state

Close or sell practice

Relocate practice within state

Stop all patient care

Start providing certain services

Retire

Stop services to specific groups

Stop providing certain services

Increase diagnostic procedures performed

Reduce patient care hours

Increase referral of complex cases

Percentage in response categorya,b

Definitely will do Might do Not anticipated Figure 2-3. Anticipated changes to practice in the next two yearsa aThis analysis excludes physicians who responded that the question was “not applicable” to their practice. bPercents do not add to 100 percent due to rounding.



50

38

7

3442

614

5230

10

20

30

40

50

60

70

80

90

100

Very satisfied Somewhat satisfied Neither satisfied nordissatisfied

Somewhat dissatisfied Very dissatisfied

Perc

enta

ge

Career overall Past 12 monthsa

Changes to hospital admitting privileges Most physicians reported that they had not made any changes to their hospital admitting privileges within the last 12 months (85 percent). Of the physicians who reported making changes, the most frequently cited reasons for the change in hospital privileges included a change in practice and increased demand for call coverage.

Satisfaction More physicians have been very satisfied with their medical career overall (50 percent) than have been very satisfied with their career within the past 12 months (34 percent). Figure 2-4 shows percentages of reported satisfaction at all levels for respondents’ careers overall and careers in the past 12 months. Figure 2-4. Respondents’ satisfaction with career overall and with career in past 12 months aPercents do not add to 100 percent due to rounding. For crosstabulations of respondents’ satisfaction ratings (for both career overall and past 12 months) by specialty, length of licensure, size of primary practice, and other characteristics, see Appendix B, Tables B-40 through B-53.



More than one-half of the respondents identified their patient relationships as their greatest source of satisfaction; 25 percent mentioned the intellectual challenge as their greatest source of satisfaction. Table 2-11 shows respondents’ reported sources of satisfaction.

Table 2-11. Greatest source of professional satisfaction

Source of satisfaction Percent

Patient relationships 52

Intellectual challenge 25

Practice environment 14

Income 6

Other 3 Physicians’ reports of the greatest source of their satisfaction varied by specialty, length of licensure, and size of primary practice. Appendix B, Tables B-54 through B-60 show the crosstabulations of sources of satisfaction by physician specialty, practice location and size, length of licensure, region (urban or rural), practice setting, and employment role.



Section 3: Acceptance of payers

Respondents were asked to indicate the payer types their practice accepted or limited as well as the major factors contributing to the decision to limit acceptance of patients by payer. Acceptance level of insurance payer types Physicians reported whether their office accepts or limits each insurance payer and uninsured patients. Table 3-1 shows the level of acceptance by payer type. Respondents reported accepting Medicaid payers (both fee-for-service and managed care) at the lowest percentages.

Table 3-1. Acceptance of payer types

Payer acceptanceb

Payer typea Accept all Limit

acceptance Accept none

Commercial 82 16 2

Medicare 73 18 9

Medicaid fee-for-service 59 27 14

Medicaid managed care 58 26 17

TRICARE/CHAMPUSc 70 14 16

Workers’ Compensation 65 18 16

Uninsured 66 28 5 aCategories are not mutually exclusive. bRow percentages may not add to 100 percent due to rounding. cTRICARE/CHAMPUS insurance programs are offered by the U.S. Department of Defense and the Veteran’s Administration, respectively. Within each payer category, there are significant differences in acceptance across practice locations and specialties. Physicians in the Portland metropolitan region reported the lowest percentages of acceptance in all payer categories (with the exception of Workers’ Compensation). Primary care physicians reported accepting Medicaid (both fee-for-service and managed care) and Medicare payers less often than physicians in other specialties.



Comparative restriction of payer types Table 3-2 compares respondents’ restrictions of each payer type with restrictions on all other payer types to determine whether payers are restricted to the same degree. The “payer type restricted” column indicates the payer under consideration. The count indicates the number of respondents who reported that their practice restricts the payer type under consideration.33 The “percentage restricting additional payer type” columns represent the additional payer types. For example, of the 375 respondents that restrict commercial insurance, 66 percent also restrict Medicare, 82 percent restrict Medicaid managed care, 80 percent restrict Medicaid fee-for-service, and so on. Practices that restrict Medicare restrict both Medicaid managed care and fee-for-service payers at high levels (88 percent and 90 percent, respectively). Physicians who reported restricting either Medicaid managed care or fee-for-service payers most often also restrict the other Medicaid payment form. Practices that restrict commercial insurance also report high percentages of restriction of other payer types and the uninsured.

Table 3-2. Comparison of restriction by payer type

Percentage restricting additional payer typea

Payer type restricted Count Commercial Medicare Medicaid

managed care Medicaid

fee-for-serviceTRICARE/ CHAMPUS

Workers’ Compensation Uninsured

Commercial 375 — 66 82 80 77 75 70

Medicare 582 42 — 88 90 71 68 65

Medicaid managed care 876 34 60 — 91 60 58 61

Medicaid fee-for-service 859 34 58 94 — 61 58 62

TRICARE/CHAMPUS 608 45 64 84 83 — 70 65

Workers’ Compensation 697 39 54 71 70 61 — 60

Uninsured 702 37 53 78 76 60 63 —

a— indicates the payer type under consideration.

33If the practice “limits acceptance” or “accepts none” (does not accept patients with this payer type), the practice is considered to restrict the payer type.



60

40

35

32

10

85

63

47

33

17

88

64

52

38

28

85

62

49

39

29

40

37

24

22

12

0 20 40 60 80 100

Reimbursement

Overhead

Balanced payer type

Liability costs

Cost of translationservices

Percentage of physicians who restrict payers and rated factor as very important

Workers' Comp

Medicaid MC

Medicaid FFS

Medicare

Commercial

Factors in decision to limit patient acceptance by payer Physicians whose practices limited or restricted patient payer types were asked to rate the importance of 12 factors in the decision to limit or restrict the payer type.34 The 12 factors were grouped into three major categories: financial, administrative, or patient-related characteristics. Figures 3-1 through 3-3 show the percentages of physicians who rated each factor as very important in their decision to restrict business for the payer type. Figure 3-1 shows that reimbursement and overhead costs are pronounced factors in physicians’ restrictions of all payer types, especially Medicare and Medicaid patients. Figure 3-1. Financial factors rated as very important in decision to limit or restrict patient payers 34Survey question 16 prompts respondents “For each of the lines of business in which you limit or DO NOT accept patients, please indicate the importance of each factor on your decision to restrict or close your practice.”



36

25

20

13

53

32

15

9

50

30

30

14

55

31

27

23

72

21

15

0 20 40 60 80 100

Administrativerequirements

Practice full

Benefit changes

HMO left market


Workers' Comp

Medicaid MC

Medicaid FFS

Medicare

Commercial

Figure 3-2 shows that administrative requirements are very important factors in the decision to restrict patients for • roughly half of physicians restricting Medicare and Medicaid payers • nearly three-quarters of physicians who restrict Workers’ Compensation as a payer

(72 percent)

Figure 3-2. Administrative factors rated as very important in decision to limit or restrict patient payers



Physicians restricting Medicaid patients cited patient-related factors as very important in the decision to restrict patients with these insurance payers. Figure 3-3 shows that patient social needs and noncompliance were considered very important factors more often by physicians whose practices limit Medicaid managed care or Medicaid fee-for-service patient payers. Figure 3-3. Patient-related factors rated as very important in decision to limit or restrict patient payers For crosstabulations of patient payer acceptance by physician specialty and practice location, see Appendix B, Tables B-61 and B-62.

10

8

6

11

19

27

39

39

27

41

38

28

26

26

29

0 20 40 60 80 100

Noncompliance

Patient social needs

Patient clinical needs


Workers’ Comp

Medicaid MC

Medicaid FFS

Medicare

Commercial



Section 4. Specialty care

The 2004 Oregon Physicians Workforce Survey focused on two primary areas of specialty care: maternity care and neurosurgery.

Maternity care

Physicians indicated whether they ever have or currently practice maternity care.35 Physicians currently practicing maternity care indicated the procedures they perform. Physicians who had practiced maternity care and reported they had ceased delivering babies ranked the factors contributing to their decision to stop delivering babies. Physicians currently delivering babies Of those who reported ever having delivered babies, 42 percent, or 226 physicians, currently deliver babies.36 More than one-half of those currently delivering are obstetrics/gynecology (ob/gyn) physicians; the remainder are mostly family practice physicians. The gender distribution of current maternity care physicians is relatively even—48 percent females and 52 percent males. Almost one-half of respondents who currently deliver babies have practices in the Portland metropolitan region (46 percent) and more than one-half have been licensed for more than 10 years (56 percent). Physicians who currently deliver babies indicated the types of procedures their maternity practice includes. Nearly all respondents indicated that they deliver babies of Medicaid patients. Table 4-1 shows the number and percentage of physicians performing each procedure, as well as the total number of respondents for each procedure.

Table 4-1. Maternity care procedures performed by physicians practicing maternity care

Physicians practicing

procedure Total

respondents

Maternity care procedure # % #

Medicaid deliveries 192 95 203

Assist cesarean 182 90 202

High-risk pregnancies or deliveries 158 74 213

Perform cesarean 128 65 197

Vaginal birth after cesarean (VBAC) 108 52 207

Appendix B, Table B-63 shows the distribution of physicians who deliver babies by gender, length of licensure, practice setting and location, and ob/gyn and specialty licenses. Tables B-64 through

35For the purposes of maternity care analyses, the practice of maternity care is defined as delivery of babies. 36In order for a physician to be included as a maternity care provider, he/she had to report performing deliveries currently or had to indicate if he/she is not currently delivering, and the length of time elapsed since stopping deliveries.



B-67 in Appendix B show crosstabulations of maternity care procedures by practice location, gender, length of licensure, and ob/gyn licensure. Physicians no longer delivering babies Of the 226 physicians currently delivering babies, 23 (10 percent) indicated that they plan to stop delivering babies in the next year. Fourteen physicians reported that they will stop all deliveries; nine physicians reported that they plan to stop Medicaid deliveries. Approximately three-quarters of the physicians who no longer deliver babies stopped deliveries more than two years ago (76 percent), and roughly one-half of all who stopped delivering had held medical licenses for more than 20 years (53 percent). The majority of physicians who reported stopping deliveries are non-ob/gyn physicians (87 percent). Appendix B, Table B-68, shows the characteristics of physicians no longer delivering babies; Table B-69 shows a crosstabulation of the time elapsed since the provider stopped delivering babies by ob/gyn licensure status. Table 4-2 on the next page shows that both ob/gyns and non-ob/gyns who stopped deliveries cited medical liability premiums most frequently as a very important factor in their decision to stop deliveries (74 and 66 percent, respectively). Time demands/personal life were also rated as very important factors by more than one-half of ob/gyn (53 percent) and non-ob/gyn physicians (58 percent) who have stopped deliveries.



Table 4-2. Very important factors in decision to stop delivering babies, by ob/gyn and non-ob/gyn physician specialties

Ob/gyn physicians Non-ob/gyn physicians Very important factor in decision to stop delivering babies # % Total # % Total

Lack of backup for cesarean sections 1 5 20 36 26 136

Time demands 19 53 36 116 58 201

Medical liability premiums 26 74 35 133 66 202

Experience with lawsuits 11 38 29 24 23 103

Lack of demand 1 6 17 17 12 142

Low reimbursement 7 23 31 19 11 173

Lack of interest 6 24 25 20 13 159

Hospital privilege issues 1 7 14 15 10 144 Appendix B, Table B-70 shows ob/gyn and non-ob/gyn respondents’ ratings of all factors in the decision to stop delivering babies.



Neurosurgery

Neurosurgeon respondents indicated whether they perform brain or spine surgery. Type of neurosurgery performed Of the 22 neurosurgeons responding to the survey, 15 currently perform brain surgery and spine surgery, 3 perform only spine surgery; 4 perform neither brain nor spine surgery. Table 4-3 shows the distribution of neurosurgeons who responded to the survey.

Table 4-3. Characteristics of neurosurgeon respondents

Characteristicsa # %

Length of licensure (N=22)

Less than 2 years 0 0

2–5 years 3 14

6–10 years 3 14

11–20 years 5 23

More than 20 years 11 50

Region (N=17)

Portland Metro 11 65

Mid-Willamette Valley 3 18

Northwestern 0 0

Southern 3 18

Eastern 0 0

Southwestern 0 0

Central 0 0

aThe N varies slightly for the total number of respondents that answered both the neurosurgery and the demographic series of questions.



Section 5. Liability insurance

Respondents indicated the source, form, and amount of liability insurance coverage, the annual premium amount, whether they had changed liability insurance sources in the past three years, and whether they had made any changes to their practice due to concerns about either the cost or availability of liability insurance coverage.

Source, form, and amount of liability insurance coverage Nearly three-quarters of the responding physicians named commercial insurance companies as their source for professional liability insurance (74 percent). Table 5-1 on the next page shows that almost half of the respondents reported that they held claims-made policies as their form of coverage; 40 percent reported carrying a $1-million-per-claim, $3-million-aggregate coverage plan.37,38

37The Medical Liability Mutual Insurance Company (MLMIC) defines claims-made policies as policies that protect policyholders for alleged acts of malpractice which both occur and are reported to the insurance company while the claims-made policy is in continuous force. MLMIC defines occurrence policies as policies that protect policyholders for alleged acts of malpractice which occur while the policy is in force, no matter when a claim against the doctor is reported to the insurance company. Available at www.mlmic.com/indexPol.htm. Accessed January 10, 2005. 38Under the Federal Tort Claims Act (FTCA), the staff of Federally Supported Health Centers (FSHCs) are considered federal employees and covered for the purposes of medical malpractice. Bree MJ, Federal Tort Claims Act and Risk Management [U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care Web site]. Available at bphc.hrsa.gov/quality/FTCASHOWnew.PPT. Accessed January 12, 2005.



Table 5-1. Source, form, and amount of liability coverage

Liability coverage characteristics Percent

Source of liability insurance

Commercial 74

Self-insured 10

State or federal Tort Claims Act 7

Other 4

Do not know 4

Form of liability coverage

Claims-made coverage 48

Occurrence coverage 22

State or federal Tort Claims Act 7

Do not know 23

Amount of coverage

Not applicable, state or federal Tort Claims Act 5

$1 million per claim; $3 million aggregate 40




Other 5

Do not know 19

Physicians reported the annual premium amount they currently pay for professional liability insurance.39 Self-reported premium amounts varied across specialties. Roughly three-quarters of physicians in surgical specialties reported premium amounts greater than $20,000 per year (76 percent). Table 5-2 shows that the median premium amount paid by a physician in a high-risk specialty—defined as general surgery, neurosurgery, obstetrics/gynecology, and orthopedic surgery —was $32,000 per year.40 Comparatively, the median premium amount for the 17 neurosurgeons who reported liability information was $54,000. The median premium amount for ob/gyn physicians is higher than the premium amount for non-ob/gyn physicians.

39If the respondent reported an annual premium amount of less than $100, the response was excluded from the analysis. 40The minimum reported annual premium amount paid is $2,000; maximum, $250,000.



Table 5-2. Liability premium levels by specialty categories

Premium amount in dollars

Specialty categorya Median Minimum Maximum

Physician specialty

Primary care 10,000 500 250,000

Medical specialties 10,000 450 80,000

Surgical specialties 30,000 2,000 147,000

Hospital-based 14,000 2,000 135,000

Other 4,500 1,000 60,000

Type of specialty care

Ob/gyn 38,000 3,000 250,000

Non-ob/gynb 10,000 1,000 145,000

Neurosurgeon 54,000 15,000 147,000

Specialty degree of risk

High-risk specialty 32,000 2,000 250,000

Not high-risk specialty 10,000 450 176,704 aCategories are not mutually exclusive. bRespondent indicated that he or she provides maternity care. Appendix B, Tables B-71 through B-76 show the liability premium categories by ob/gyn licensure, physician specialty, hospital status, neurosurgery licensure, pediatric specialty licensure, and high-risk specialty licensure. Changes made or anticipated regarding liability insurance Changes to liability insurance source Three-quarters of responding physicians have not changed professional liability insurance sources in the past three years. Those who have changed sources most commonly cited changes in practice setting or employment (37 percent) or an increase in premium rates (32 percent) as principal reasons for making the change. Practice changes made due to concerns about liability insurance cost or availability Physicians reported on practice changes that they have made or anticipate making due to concerns regarding the cost or availability of liability insurance coverage. Figure 5-3 shows that the most frequently cited changes that physicians have already made or definitely will make are increasing referral of complex cases, stopping the provision of certain services, and increasing diagnostic procedures performed.



1

1

1

1

1

1

5

8

8

9

11

5

2

1

2

2

1

5

4

6

4

12

17

13

7

10

11

5

16

17

13

14

19

77

84

91

87

86

92

74

71

73

73

59

0 20 40 60 80 100

Retire



Stop all direct patient care





Increase diagnostic proceduresperformed



Percentage in response categorya

Already have done Definitely will do May consider doing Nothing anticipated

Figure 5-3. Possible practice changes regarding cost or availability of liability insurance coverage aBar percentages may not add to 100 percent due to rounding. See Appendix B, Table B-77 for the distribution of actions regarding concerns about the cost or availability of liability insurance coverage.



Physicians’ responses regarding nearly all possible practice changes vary by practice location, length of licensure, or physician specialty. Appendix B, Tables B-78 through B-80 show the possible changes and responses by physician specialty, practice location, and length of licensure.

2004 Oregon Physician Workforce Survey Further Research


Further Research This 2004 Oregon Physician Workforce Survey Report is one part of a larger, ongoing effort to study and understand patient access to the physician workforce in the state. Individual stakeholders will act as separate entities to conduct further analyses, discuss findings, and formulate conclusions and recommendations for healthcare policies and programs in Oregon. The steering committee that guided the preparation of the survey and report included one representative from each organization:

Scott Gallant Director of Government Affairs Oregon Medical Association

Jeanene Smith Deputy Administrator Office for Oregon Health Policy and Research

Charles Gallia Evaluation Program Coordinator Office of Medical Assistance Programs

David Shute Medical Director OMPRO

The workgroup that conducted the survey administration, data collection and analysis, and the production of this report includes the following:

Joy Conklin Director of Socioeconomic Affairs Oregon Medical Association

Tina Edlund Research and Data Manager Office for Oregon Health Policy and Research

Jennifer Pathak Contract Manager OMPRO

Yelena Rozenfeld Data Analysis Manager OMPRO Jean Schnadig Project Coordinator OMPRO

2004 Oregon Physician Workforce Survey Further Research


For more information on the 2004 Physician Workforce Survey or this report, please contact Charles Gallia Evaluation Program Coordinator Oregon Department of Human Services, Health Services Office of Medical Assistance Programs 500 Summer Street NE E-35 Salem OR 97301-1077 or Joy Conklin Director of Socioeconomic Affairs Oregon Medical Association 5210 SW Corbett Avenue Portland, OR 97239

Office of Medical Assistance Programs C-1

Appendix A. Data comparison and categorization tables

Demographic characteristics Survey sampleBME 2004

census dataGender

Male 73 73Female 27 27

RegionPortland metropolitan 45 50Northwestern 6 5Mid-Willamette valley 23 21Southwestern 15 14Central 7 7Eastern 4 3

AgeUnder 40 20 2440–49 28 2850–59 33 2960–69 16 1370 and older 4 6

Table A-1. Demographic characteristics for comparison between 2004 Oregon Physician Workforce Survey sample and Oregon Board of Medical Examiners 2004 census data

Percentage

Office of Medical Assistance Programs A-1

2004 Oregon Physician Workforce Survey Appendix A

Table A-2. Oregon regions and counties within each region

Region CountiesPortland metropolitan Washington, Multnomah, Clackamas, Yamhill Mid-Willamette valley Linn, Benton, Marion, Polk, Lane Northwestern Clatsop, Tillamook, Columbia, Lincoln Southern Jackson, Douglas, Josephine Eastern Baker, Umatilla, Morrow, Grant, Wallowa, Union, Malheur, HarneySouthwestern Coos, Curry Central Jefferson, Crook, Deschutes, Lake, Klamath, Hood River, Wasco,

Sherman, Gilliam, Wheeler



Table A-3. Unique physician specialties assigned to major specialty groups

Unique physician specialty Major specialty groupAdolescent medicine Primary careBehavioral pediatrics Primary careClinical & laboratory immunology Primary careDevelopmental behavioral pediatrics Primary careFamily practice Primary carePortland metropolitan Primary careGeneral practice Primary careMid-Willamette valley Primary careSouthwestern Primary careHospice Primary careHouse calls Primary careInternal medicine Primary careLactation Primary careObstetrics Primary careObstetrics-gynecology Primary carePediatric sports medicine Primary carePediatrics Primary carePreventive medicine Primary carePrimary care Primary careUrgent care Primary careAllergy & immunology Medical specialtyBone densitometry Medical specialtyBroncho-esophagology Medical specialtyCardiac electrophysiology Medical specialtyCardiology Medical specialtyCardiovascular disease Medical specialtyCerebrovascular disease Medical specialtyChild neurology Medical specialtyChronic wound care Medical specialtyClinical hypertension Medical specialtyClinical neurophysiology Medical specialtyConservative care of the spine Medical specialtyCornea & external disease Medical specialtyCritical care medicine Medical specialtyCystic fibrosis Medical specialtyDermatological immunology Medical specialtyDermatology Medical specialtyDermatopathology Medical specialtyDiabetes Medical specialtyDiabetic foot care Medical specialtyElectrodiagnosis neuro Medical specialtyElectrophysiology neuro Medical specialtyEndocardiography Medical specialtyEndocrinology & metabolism Medical specialtyEpilepsy neuro Medical specialtyGastroenterology Medical specialtyGlaucoma Medical specialtyGynecologic oncology Medical specialty




Unique physician specialty Major specialty groupHematology Medical specialtyHematology-oncology Medical specialtyHepatitis C Medical specialtyImmunohistocompatibility Medical specialtyInfectious disease Medical specialtyInfertility Medical specialtyInterventional cardiology Medical specialtyLaryngology Medical specialtyLipid metabolism Medical specialtyMaternal fetal medicine Medical specialtyMedical oncology Medical specialtyMedicine Medical specialtyMovement disorders Medical specialtyMultiple sclerosis Medical specialtyNeonatal-perinatal medicine Medical specialtyNeoplastic disease Medical specialtyNephrology Medical specialtyNeuro muscular Medical specialtyNeurodevelopmental disabilities Medical specialtyNeuroimmunology Medical specialtyNeurology Medical specialtyNeurology oncology Medical specialtyNeuromuscular disease Medical specialtyNon-invasive cardiology Medical specialtyNuclear cardiology Medical specialtyNuclear medicine Medical specialtyNutrition Medical specialtyOncology Medical specialtyOphthalmolic oncology Medical specialtyOphthalmology Medical specialtyOrthopaedic oncology Medical specialtyOsteopathic manipulative medicine Medical specialtyOsteoporosis Medical specialtyOtolaryngology Medical specialtyOtology-neurotology Medical specialtyPain management Medical specialtyPalliative medicine Medical specialtyPediatric allergy Medical specialtyPediatric cardiology Medical specialtyPediatric endocrinology Medical specialtyPediatric gastroenterology Medical specialtyPediatric hematology-oncology Medical specialtyPediatric infectious disease Medical specialtyPediatric internal medicine Medical specialtyPediatric nephrology Medical specialtyPediatric neurology Medical specialtyPediatric oncology Medical specialtyPediatric pulmonology Medical specialtyPediatric rheumatology Medical specialty




Unique physician specialty Major specialty groupPhlebology-vein care Medical specialtyPhysical medicine & rehabiliation Medical specialtyPreventative cardiology Medical specialtyPulmonary Medical specialtyPulmonary critical care Medical specialtyPulmonary disease Medical specialtyPulmonology Medical specialtyReproductive endocrinology Medical specialtyRespiratory disease Medical specialtyRetina Medical specialtyRheumatology Medical specialtySkin cancer Medical specialtySleep medicine Medical specialtySomnology Medical specialtySpinal cord injury medicine Medical specialtySports medicine Medical specialtyStroke Medical specialtyThoracic oncology Medical specialtyUrinary incontinence Medical specialtyUrogynecology Medical specialtyUrologic oncology Medical specialtyUrology Medical specialtyVascular medicine Medical specialtyVitreoretinal disease Medical specialtyWeight control Medical specialtyAbdominal surgery Surgical specialtyAdult reconstructive orthopedics Surgical specialtyArthroscopy Surgical specialtyBariatric surgery Surgical specialtyBreast surgery Surgical specialtyBurn surgery Surgical specialtyCancer surgery Surgical specialtyCardiothoracic surgery Surgical specialtyCardiovascular surgery Surgical specialtyCataract Surgical specialtyCataract Surgical specialtyColon & rectal surgery-proctology Surgical specialtyCornea & refractive surgery Surgical specialtyCosmetic medicine Surgical specialtyCraniofacial surgery Surgical specialtyCritical care surgery Surgical specialtyDermatologic surgery Surgical specialtyElectrosurgeon Surgical specialtyEndoscopy Surgical specialtyFoot & ankle orthopedics Surgical specialtyForensic otolaryngology Surgical specialtyGeneral surgery Surgical specialtyHand surgery Surgical specialtyHead & neck surgery Surgical specialty




Unique physician specialty Major specialty groupHip & knee replacement Surgical specialtyJoint replacement Surgical specialtyKnee Surgical specialtyLaparoscopic surgery Surgical specialtyLower extremity reconstructure Surgical specialtyMaxillofacial surgery Surgical specialtyMicrographic surgery Surgical specialtyNeuro ophthalmology Surgical specialtyNeurological surgery Surgical specialtyOculoplastics Surgical specialtyOral & maxillofacial surgery Surgical specialtyOral surgery Surgical specialtyOrbital Surgical specialtyOrthopedic surgery Surgical specialtyOrthopedic trauma Surgical specialtyPediatric cardiothoracic surgery Surgical specialtyPediatric maxillofacial surgery Surgical specialtyPediatric neurosurgery Surgical specialtyPediatric ophthalmology Surgical specialtyPediatric orthopedics Surgical specialtyPediatric otolaryngology Surgical specialtyPediatric surgery Surgical specialtyPediatric urology Surgical specialtyPelvic floor reconstruction Surgical specialtyPeripheral vascular Surgical specialtyPlastic surgery Surgical specialtyPlastic surgery-facial Surgical specialtyPulmonary surgery Surgical specialtyReconstructive surgery Surgical specialtyRefractive surgery Surgical specialtyRenal transplant Surgical specialtyRhinology Surgical specialtyShoulder & knee Surgical specialtyShoulder/elbow Surgical specialtyShoulders, hip & knee Surgical specialtySpine deformity Surgical specialtySpine surgery Surgical specialtyStrabismus Surgical specialtySurgical assisting Surgical specialtySurgical critical care Surgical specialtySurgical oncology Surgical specialtyThoracic surgery Surgical specialtyTransplant surgery Surgical specialtyTrauma surgery Surgical specialtyVascular surgery Surgical specialtyVitreoretinal surgery Surgical specialtyAnatomical pathology Hospital-basedAnesthesiology Hospital-basedBody imaging Hospital-based




Unique physician specialty Major specialty groupBreast imaging Hospital-basedCardiac anesthesia Hospital-basedChemical pathology Hospital-basedClinical pathology Hospital-basedCytopathology Hospital-basedDiagnostic radiology Hospital-basedEmergency medicine Hospital-basedForensic pathology Hospital-basedHematopathology Hospital-basedHospitalist Hospital-basedImmunopathology Hospital-basedIntensive care Hospital-basedInterventional radiology Hospital-basedMammography Hospital-basedMaxillofacial radiology Hospital-basedMRI Hospital-basedMusculoskeletal radiology Hospital-basedNeuroanesthesia Hospital-basedNeurointerventional radiology Hospital-basedNeuropathology Hospital-basedNeuroradiology Hospital-basedNuclear radiology Hospital-basedOB anesthesia Hospital-basedOBGYN pathology Hospital-basedPathologic anatomy Hospital-basedPathology Hospital-basedPediatric anesthesiology Hospital-basedPediatric critical care Hospital-basedPediatric emergency medicine Hospital-basedPediatric pathology Hospital-basedPediatric radiology Hospital-basedRadiation anesthesiology Hospital-basedRadiation oncology Hospital-basedRadioisotopic pathology Hospital-basedRadiological physics Hospital-basedRadiology Hospital-basedRadiology diagnostic Hospital-basedRadiology oncology Hospital-basedRenal pathology Hospital-basedSurgical pathology Hospital-basedTherapeutic radiology Hospital-basedUnderseas medicine Hospital-basedVascular & interventional radiology Hospital-basedWomen's imaging Hospital-basedAcupuncture OtherAddiction medicine OtherAddiction psychiatry OtherADHD OtherAdministrative medicine Other




Unique physician specialty Major specialty groupAdolescent psychiatry OtherAerospace medicine OtherAlternative OtherAnxiety disorders OtherAviation medicine OtherBlood banking-transfusion medicine OtherChild & adolescent psychiatry OtherChild abuse OtherChild psychiatry OtherChiropractic OtherClinical biochemical genetics OtherClinical biochemical-molecular genetics OtherClinical cytogenics genetics OtherClinical genetics OtherClinical molecular genetics OtherCommunity psychiatry OtherConsulting pyschiatry OtherCorrectional medicine OtherDialysis access OtherDisability determination OtherDNA OtherEpidemiology OtherFeeding disorders OtherForensic psychiatry OtherGeriatric psychiatry OtherHistopath OtherHolistic medicine OtherIndependent medical evaluations OtherIndustrial medicine OtherIntegrative medicine OtherLegal medicine OtherManipulation OtherMedical ethics OtherMedical genetics OtherMedical informatics OtherMedical microbiology OtherMedical research OtherMedical toxicology OtherNeuropsychiatry OtherOccupational medicine OtherOther OtherPharmacology OtherPsychiatry OtherPsychiatry-adult OtherPsychoanalysis OtherPsychoanalysis-adult OtherPsychoanalysis-child OtherPsychoanalytic therapy Other




Unique physician specialty Major specialty groupPsychopharmacology OtherPsychosomatic medicine OtherPsychotherapy OtherPublic health OtherQuality improvement OtherStress management OtherTransfusion medicine OtherTropical/travel medicine Other


Appendix B. Crosstabulations of survey data

2004 Oregon Physician Workforce Survey Appendix B

A guide to the data tables in Appendix B

Table B-2. Practice location by physician specialty

33b. Setting and ownership32. What is your primary specialty?

Practice locationPrimary

careMedical

specialtiesSurgical

specialtiesHospital-

based Other TotalPortland Metro # 364 214 92 116 81 867

% 42 25 11 13 9 100

Mid-Willamette Valley # 207 89 44 52 34 426% 49 21 10 12 8 100

Northwestern # 28 3 6 10 3 50% 56 6 12 20 6 100

Southern # 101 41 25 26 14 207% 49 20 12 13 7 100

Eastern # 43 6 11 11 3 74% 58 8 15 15 4 100

Southwestern # 21 9 5 5 3 43% 49 21 12 12 7 100

Central # 84 33 19 24 10 170% 49 19 11 14 6 100

Chi-square value = 33.533 p<0.093↑ The chi-square test statistic is used to check for a statistically significant association between two variables. If the p value is less than 0.05, then the chi-square test statistic provides strong evidence that there is association between two variables. The p value for the chi-square test of variables in Table B-2 indicates that there is no association between practice location and physician specialty.

↑ The percentages under each column header indicate the percentage of respondents. For example, the 364 primary care physicians responding from Portland make up 42 percent of all physicians responding from Portland

← Relevant question groups from the 2004 Oregon Physician Workforce Survey appear below the table title. The full survey questionnaire appears in Appendix C.

Each appendix table shows the crosstabulations of multivariate responses (such as practice location by physician specialty shown in Table B-2). The tables show the count, or number of responses, for each table cell, the total responses for each row, and the percentage of responses. An annotated explanation of an example from Table B-2 appears in the shaded areas.

← The total column indicates the total number of respondents within the region. For example, 867 physicians with a practice in the Portland metropolitan region responded to the survey.

↑ The numbers, or counts, under each column header indicate the number of respondents in each physician specialty in the region. For example, 364 primary care physicians with a practice located in the Portland metropolitan region responded to the survey.

Office of Medical Assistance Programs B-3

Section 1. Respondent demographics


Table B-1. Practice location by age of respondent

33b. Setting and ownership2. What is your age group?

Practice locationUnder 40

years40–49 years

50–59 years

60–69 years

70 years and over Total

Portland Metro # 176 254 297 117 23 867% 20 29 34 13 3 100

Mid-Willamette valley # 90 122 153 53 8 426% 21 29 36 12 2 100

Northwestern # 8 11 21 10 — 50% 16 22 42 20 — 100

Southern # 40 61 67 33 6 207% 19 29 32 16 3 100

Eastern # 16 20 28 6 4 74% 22 27 38 8 5 100

Southwestern # 12 15 10 6 — 43% 28 35 23 14 — 100

Central # 38 51 63 18 2 172% 22 30 37 10 1 100

Chi-square value = 19.789 p<0.709Note: — indicates no responses in the category.

Age



Table B-2. Practice location by physician specialty

33b. Setting and ownership32. What is your primary specialty?

Practice locationPrimary

careMedical

specialtiesSurgical


based Other Total

Portland # 364 214 92 116 81 867% 42 25 11 13 9 100


Northwestern # 28 3 6 10 3 50% 56 6 12 20 6 100

Southern # 101 41 25 26 14 207% 49 20 12 13 7 100

Eastern # 43 6 11 11 3 74% 58 8 15 15 4 100

Southwestern # 21 9 5 5 3 43% 49 21 12 12 7 100

Central # 84 33 19 24 10 170% 49 19 11 14 6 100

Chi-square value = 33.533 p<0.093

Physician specialty


Section 2. Practice environment


Table B-3. Distribution of physician specialties32. What is your primary specialty?

Physician specialty # %Family practice 453 18Internal medicine 314 12Pediatrics 188 7Obstetrics/gynecology 173 7Emergency medicine 140 6Anesthesiology 125 5Psychiatry 120 5Orthopedics 107 4Ophthalmology 84 3General surgery 80 3Radiology 73 3Neurology 50 2Cardiology 47 2Otolaryngology 42 2Urology 36 1Surgery 34 1Dermatology 33 1Oncology 33 1General practice 32 1Gastroenterology 31 1Pathology 30 1Child and adolescent psychiatry 27 1Physical medicine and rehab 24 1Neurosurgery 22 1Plastic surgery 21 1Unknown* 19 1Nephrology 18 1Pulmonary medicine 18 1Occupational medicine 15 1Endocrinology 13 1Allergy 12 Less than 1%Neonatal medicine 11 Less than 1%Rheumatology 11 Less than 1%Hospital medicine 10 Less than 1%Hematology 8 Less than 1%Urgent care 8 Less than 1%Infectious disease 7 Less than 1%Pain medicine 6 Less than 1%



Table B-3. Distribution of physician specialties32. What is your primary specialty?

Nuclear medicine 5 Less than 1%Colon and rectal surgery 4 Less than 1%Critical care medicine 4 Less than 1%Osteopathic medicine 4 Less than 1%Addiction medicine 3 Less than 1%Geriatrics 3 Less than 1%Medical acupuncture 3 Less than 1%Preventive medicine 3 Less than 1%Reproductive endocrinology 3 Less than 1%Medical genetics 2 Less than 1%Psychology 2 Less than 1%Administrative medicine 1 Less than 1%Biochemical genetics 1 Less than 1%Eating disorders 1 Less than 1%Functional medicine 1 Less than 1%Manual medicine 1 Less than 1%Medical resident 1 Less than 1%Otology 1 Less than 1%Respiratory disease 1 Less than 1%Sleep medicine 1 Less than 1%Sports medicine 1 Less than 1%Surgical pathology 1 Less than 1%

Note: percents do not add to exactly 100% due to rounding.* The 19 physicians with unknown specialties (handwriting illegible or response was not readily categorizable into an initial set of 500 medical specialties) were retained because the respondents had completed at least 60 percent of the core survey questions.



Table B-4. Practice setting by practice location

33b. Setting and ownership33b. Setting and ownership

Practice settingPortland

Metro

Mid-Willamette

ValleyNorth-

western Southern EasternSouth-

western Central TotalHospital # 348 192 26 84 36 21 79 786

% 44 24 3 11 5 3 10 100

Clinic, private, for-profit # 499 247 21 146 46 35 108 1102% 45 22 2 13 4 3 10 100

Clinic, private, not-for-profit # 99 66 5 14 8 1 11 204% 49 32 2 7 4 0 5 100

Clinic, public # 36 13 7 7 3 11 77 —% 47 17 9 9 4 14 100 —

Other # 26 14 2 6 2 7 57 —% 46 25 4 11 4 12 100 —

Note: — indicates no responses in the category.

Practice location



Table B-5. Practice setting by physician specialty33b. Setting and ownership32. What is your primary specialty?

Practice setting Primary careMedical

specialtiesSurgical


based Other TotalHospital # 374 194 123 326 27 1044

% 36 19 12 31 3 100

Clinic, private, for-profit # 646 357 180 44 99 1326% 49 27 14 3 7 100

Clinic, private, not-for-profit # 164 45 22 12 33 276% 59 16 8 4 12 100

Clinic, public # 73 12 6 2 23 116% 63 10 5 2 20 100

Other # 39 10 7 6 15 77% 51 13 9 8 19 100

Physician specialty



Table B-6. Practice setting by length of licensure

33b. Setting and ownership6. How long have you had a medical license in any state, including Oregon?

Practice settingLess than 2 years 2–5 years 6–10 years

11–20 years

More than 20 years Total

Hospital # 21 108 180 329 408 1046% 2 10 17 31 39 100

Clinic, private, for-profit # 13 93 212 387 622 1327% 1 7 16 29 47 100

Clinic, private, not-for-profit # 3 29 39 84 121 276% 1 11 14 30 44 100

Clinic, public # 1 16 12 33 54 116% 1 14 10 28 47 100

Other # 4 6 21 46 77 —% 5 8 27 60 100 —

Note: — indicates no responses in the category.

Length of licensure



Table B-7. Retirement plan by physician specialty

32. What is your primary specialty?7. When do you plan to retire?

Physician specialtyWithin the

next 2 yearsIn the next 2–5 years

More than 5 years from now Total

Primary care # 46 169 893 1108% 4 15 81 100

Medical specialties # 37 92 398 527% 7 17 76 100

Surgical specialties # 19 70 179 268% 7 26 67 100

Hospital-based # 16 53 321 390% 4 14 82 100

Other # 9 30 154 193% 5 16 80 100


Retirement plans



Table B-8. Age by plans to retire

2. What is your age group?7. When do you plan to retire?

AgeWithin the



Under 40 years # — 6 519 525% — 1 99 100

40–49 years # 10 24 697 731% 1 3 95 100

50–59 years # 29 175 630 834% 3 21 76 100

60–69 years # 72 184 90 346% 21 53 26 100

70 years and over # 18 26 16 60% 30 43 27 100


Retirement plans



Table B-9. Retirement plan by practice location

33b. Setting and ownership7. When do you plan to retire?

Practice locationWithin the



Portland Metro # 39 135 690 864% 5 16 80 100

Mid-Willamette Valley # 25 80 321 426% 6 19 75 100

Northwestern # 4 12 34 50% 8 24 68 100

Southern # 11 42 151 204% 5 21 74 100

Eastern # 4 10 59 73% 5 14 81 100

Southwestern # 3 6 34 43% 7 14 79 100

Central # 7 36 128 171% 4 21 75 100


Retirement plans



6. How long have you had a medical license in any state, including Oregon?32. What is your primary specialty?

Length of licensurePrimary

careMedical

specialtiesSurgical


based Other TotalLess than 2 years # 27 9 2 8 3 49

% 55 18 4 16 6 100

2–5 years # 138 32 12 33 14 229% 60 14 5 14 6 100

6–10 years # 195 71 29 57 14 366% 53 19 8 16 4 100

11–20 years # 289 163 80 138 57 727% 40 22 11 19 8 100

More than 20 years # 463 256 144 157 108 1128% 41 23 13 14 10 100


Physician specialty

Table B-10. Physician speciality by length of licensure



Table B-11. Ownership or employment status by practice location

34c. Employment33b. Setting and ownership

OwnershipPortland

Metro

Mid-Willamette

ValleyNorth-

western Southern EasternSouth-

western Central TotalFull or part owner of practice # 421 216 17 131 44 29 86 944

% 45 23 2 14 5 3 9 100

Employee of practice or health system # 238 120 21 41 17 4 36 477% 50 25 4 9 4 1 8 100

Independent contractor # 35 19 5 7 3 2 16 87% 40 22 6 8 3 2 18 100

Volunteer # — 2 — — — 1 — 3% — 67 — — — 33 — 100

Other # 10 5 — 1 1 — 2 19% 53 26 — 5 5 — 11 100


Practice location



Table B-12. Ownership or employment status by physician specialty

34c. Employment32. What is your primary specialty?

OwnershipPrimary

careMedical

specialtiesSurgical


based Other TotalFull or part owner of practice # 474 293 158 143 78 1146

% 41 26 14 12 7 100

Employee of practice or health system # 378 107 47 101 60 693% 55 15 7 15 9 100

Independent contractor # 31 20 9 53 16 129% 24 16 7 41 12 100

Volunteer # 2 1 1 — 1 5% 40 20 20 — 20 100

Other # 15 6 1 5 3 30% 50 20 3 17 10 100


Physician specialty



Table B-13. Ownership or employment status by length of licensure

34c. Employment6. How long have you had a medical license in any state, including Oregon?

OwnershipLess than 2 years 2–5 years 6–10 years

11–20 years


Full or part owner of practice # 4 53 177 353 558 1145% 0 5 15 31 49 100



Volunteer # — — 1 — 4 5% — — 20 — 80 100

Other # — 3 2 6 19 30% — 10 7 20 63 100


Length of licensure



29. What is the size of your primary practice, that is, the practice in which you spend the most time?6. How long have you had a medical license in any state, including Oregon?

Size of practiceLess than 2 years 2–5 years 6–10 years

11–20 years


Solo practice # 3 30 60 162 319 574% 1 5 10 28 56 100

Small group practice (2–4 physicians) # 7 46 72 170 229 524% 1 9 14 32 44 100

Medium group practice (5–9 physicians) # 7 58 86 122 196 469% 1 12 18 26 42 100

Large group practice (10 or more physicians) # 11 67 136 256 341 811% 1 8 17 32 42 100


29. What is the size of your primary practice, that is, the practice in which you spend the most time?33b. Setting and ownership

Size of practicePortland

Metro

Mid-Willamette

ValleyNorth-

western Southern EasternSouth-western Central Total

Solo practice # 221 88 11 64 26 11 46 467% 47 19 2 14 6 2 10 100

Small group practice (2–4 physicians) # 160 81 22 54 38 4 39 398% 40 20 6 14 10 1 10 100

Medium group practice (5–9 physicians) # 133 95 12 51 7 12 43 353% 38 27 3 14 2 3 12 100

Large group practice (10 or more physicians) # 311 152 3 34 2 16 37 555% 56 27 1 6 0 3 7 100


Table B-14. Practice size by length of licensure

Length of licensure

Practice location

Table B-15. Practice size by practice location



29. What is the size of your primary practice, that is, the practice in which you spend the most time?32. What is your primary specialty?

Size of primary practicePrimary

careMedical

specialtiesSurgical


based Other TotalSolo practice # 231 129 100 26 87 573

% 40 23 17 5 15 100





Physician specialty

Table B-16. Practice size by physician specialty



32. What is your primary specialty?35. In a typical week, how many new patients do you see?

Physician specialty 0–7 days 8–14 days 15–30 days

More than 30

days TotalPrimary care # 483 177 163 75 898

% 54 20 18 8 100

Medical specialties # 143 125 126 72 466% 31 27 27 15 100

Surgical specialties # 97 57 44 30 228% 43 25 19 13 100

Hospital-based # 45 5 — 6 56% 80 9 — 11 100

Other # 43 38 41 25 147% 29 26 28 17 100


Table B-17. Physician specialty by lead time to appointment for new patients

Lead time



32. What is your primary specialty?35. In a typical week, how many established patients do you see?

Physician specialty 0–7 days 8–14 days 15–30 days

More than 30

days TotalPrimary care # 691 126 78 20 915

% 76 14 9 2 100



Hospital-based # 40 4 3 — 47% 85 9 6 — 100

Other # 92 31 24 — 147% 63 21 16 — 100


Table B-18. Lead time to appointment for established patients by physician specialty

Lead time



33b. Setting and ownership35. In a typical week, how many new patients do you see?

Practice location 0–7 days 8–14 days 15–30 days

More than 30

days TotalPortland Metro # 296 154 135 72 657

% 45 23 21 11 100

Mid-Willamette Valley # 146 62 65 36 309% 47 20 21 12 100

Northwestern # 19 7 6 3 35% 54 20 17 9 100

Southern # 69 25 41 27 162% 43 15 25 17 100

Eastern # 31 11 14 6 62% 50 18 23 10 100

Southwestern # 11 13 8 4 36% 31 36 22 11 100

Central # 61 29 21 16 127% 48 23 17 13 100


Table B-19. Lead time to appointment for new patients by practice location

Lead time



33b. Setting and ownership35. In a typical week, how many established patients do you see?

Practice Location 0–7 days 8–14 days 15–30 days

More than 30

days TotalPortland Metro # 412 140 78 20 650

% 63 22 12 3 100


Northwestern # 24 8 3 — 35% 69 23 9 — 100

Southern # 102 24 32 4 162% 63 15 20 2 100

Eastern # 42 10 8 2 62% 68 16 13 3 100

Southwestern # 22 7 3 3 35% 63 20 9 9 100

Central # 91 13 16 7 127% 72 10 13 6 100


Lead time

Table B-20. Lead time to appointment for established patients by practice location



Table B-21. Patient caseload by length of licensure

6. How long have you had a medical license in any state, including Oregon?35. In a typical week, how many new and established patients do you see?

Length of licensure0 total

patients1–25 total patients

26–50 total

patients

51–75 total

patients

76–100 total

patients

More than 100 total patients Total

Less than 2 years # 11 6 2 5 3 3 30% 37 20 7 17 10 10 100

2–5 years # 37 18 31 51 50 16 203% 18 9 15 25 25 8 100

6–10 years # 43 46 74 68 94 34 359% 12 13 21 19 26 9 100

11–20 years # 122 101 151 129 132 83 718% 17 14 21 18 18 12 100

More than 20 years # 144 196 211 210 185 157 1103% 13 18 19 19 17 14 100


Number of patients seen per week



Table B-22. Patient caseload by practice location

33b. Setting and ownership35. In a typical week, how many new and established patients do you see?

Practice location0 total


26–50 total

patients

51–75 total

patients

76–100 total

patients


Portland Metro # 99 130 176 182 158 91 836% 12 16 21 22 19 11 100

Mid-Willamette Valley # 48 53 67 88 106 61 423% 11 13 16 21 25 14 100

Northwestern # 7 3 13 9 13 4 49% 14 6 27 18 27 8 100

Southern # 28 26 40 47 35 29 205% 14 13 20 23 17 14 100

Eastern # 6 9 16 16 14 12 73% 8 12 22 22 19 16 100

Southwestern # 4 5 7 1 12 14 43% 9 12 16 2 28 33 100

Central # 20 20 29 31 40 26 166% 12 12 17 19 24 16 100





32. What is your primary specialty?35. In a typical week, how many new and established patients do you see?

Physician specialty 0 total


26–50 total

patients

51–75 total

patients

76–100 total

patients


Primary care # 57 129 155 228 315 183 1067% 5 12 15 21 30 17 100

Medical specialties # 26 71 145 124 74 75 515% 5 14 28 24 14 15 100

Surgical specialties # 10 49 71 69 44 18 261% 4 19 27 26 17 7 100

Hospital-based # 247 49 26 18 22 13 375% 66 13 7 5 6 3 100

Other # 7 71 72 23 8 4 185% 4 38 39 12 4 2 100



Table B-23. Patient caseload by physician specialty



1. What is your gender?33a. Number of hours per week in direct patient care

Gender

Less than 20 hours per week

20–39 hours per

week

40–60 hours per

week

More than 60 hours per week Total

Female # 82 228 256 130 696% 12 33 37 19 100

Male # 187 359 762 507 1815% 10 20 42 28 100


2. What is your age group?33a. Number of hours per week in direct patient care

Age


20–39 hours per

week

40–60 hours per

week


Under 40 years # 38 128 204 157 527% 7 24 39 30 100

40–49 years # 72 154 308 200 734% 10 21 42 27 100

50–59 years # 75 187 359 218 839% 9 22 43 26 100

60–69 years # 60 93 132 65 350% 17 27 38 19 100

70 years and over # 24 25 16 2 67% 36 37 24 3 100


Table B-24. Hours worked per week by gender

Table B-25. Hours worked per week by age

Hours worked per week




Table B-26. Hours worked per week by practice location33b. Setting and ownership33a. Number of hours per week in direct patient care

Practice location


20–39 hours per

week

40–60 hours per

week


Portland Metro # 81 192 383 213 869% 9 22 44 25 100


Northwestern # 5 12 24 9 50% 10 24 48 18 100

Southern # 12 39 81 76 208% 6 19 39 37 100

Eastern # 2 16 25 31 74% 3 22 34 42 100

Southwestern # 4 8 14 17 43% 9 19 33 40 100

Central # 19 38 65 50 172% 11 22 38 29 100





32. What is your primary specialty?33a. Number of hours per week in direct patient care

Physician specialty


20–39 hours per

week

40–60 hours per

week


Primary care # 120 267 455 272 1114% 11 24 41 24 100

Medical Specialities # 46 121 227 140 534% 9 23 43 26 100


Hospital-based # 32 98 180 83 393% 8 25 46 21 100

Other # 39 73 61 23 196% 20 37 31 12 100



Table B-27. Hours worked per week by physician speciality



Table B-28. Hours spent on administrative tasks by practice location33b. Setting and ownership

Practice locationLess than 5 hours 5–9 hours

10–14 hours

15–19 hours

20 or more hours Total

Portland Metro # 163 251 243 81 112 850% 19 30 29 10 13 100


Northwestern # 7 11 16 9 7 50% 14 22 32 18 14 100

Southern # 25 63 55 19 44 206% 12 31 27 9 21 100

Eastern # 14 17 21 10 12 74% 19 23 28 14 16 100

Southwestern # 9 12 19 2 1 43% 21 28 44 5 2 100

Central # 35 41 53 22 19 170% 21 24 31 13 11 100


36. In a typical week, how many hours do you spend doing administrative tasks related to direct inpatient and outpatient care?

Hours spent on administrative tasks



Table B-29. Hours spent on administrative tasks by physician specialty32. What is your primary specialty?

Physician specialtyLess than 5 hours 5–9 hours

10–14 hours

15–19 hours


Primary care # 162 316 340 128 150 1096% 15 29 31 12 14 100

Medical specialties # 80 158 151 61 71 521% 15 30 29 12 14 100

Surgical specialties # 50 65 75 28 42 260% 19 25 29 11 16 100

Hospital-based # 134 105 80 19 40 378% 35 28 21 5 11 100

Other # 58 60 40 17 18 193% 30 31 21 9 9 100






Table B-30. Hours spent on administrative tasks by length of licensure6. How long have you had a medical license in any state, including Oregon?

Length of licensureLess than 5 hours 5–9 hours

10–14 hours

15–19 hours


Less than 2 years # 5 14 15 3 9 46% 11 30 33 7 20 100

2–5 years # 31 60 82 25 27 225% 14 27 36 11 12 100

6–10 years # 57 92 103 47 62 361% 16 25 29 13 17 100

11–20 years # 125 200 203 82 104 714% 18 28 28 11 15 100

More than 20 years # 261 341 284 96 121 1103% 24 31 26 9 11 100


Table B-31. Hours spent on administrative tasks by gender1. What is your gender?

GenderLess than 5 hours 5–9 hours

10–14 hours

15–19 hours


Female # 127 207 192 71 83 680% 19 30 28 10 12 100

Male # 356 497 492 181 239 1765% 20 28 28 10 14 100








Table B-32. Hours on call by length of licensure6. How long have you had a medical license in any state, including Oregon?30. In a typical week, how many hours do you spend on call?

Length of licensureNo on-call

hours1–10

hours/week11–20

hours/week21–30

hours/week

More than 30

hours/weekAlways on

call TotalLess than 2 years # 5 5 9 6 3 — 28

% 18 18 32 21 11 — 100

2–5 years # 40 26 27 48 38 21 200% 20 13 14 24 19 11 100

6–10 years # 43 55 62 71 86 35 352% 12 16 18 20 24 10 100

11–20 years # 107 92 95 132 183 90 699% 15 13 14 19 26 13 100

More than 20 years # 229 120 137 176 277 147 1086% 21 11 13 16 26 14 100


Number of hours on call



Table B-33. Hours on call by practice location

33b. Setting and ownership30. In a typical week, how many hours do you spend on call?

Practice locationNo on-call

hours1–10

hours/week11–20

hours/week21–30

hours/week

More than 30

hours/weekAlways on

call TotalPortland Metro # 137 114 117 142 191 125 826

% 17 14 14 17 23 15 100

Mid-Willamette Valley # 83 55 63 96 94 27 418% 20 13 15 23 22 6 100

Northwestern # 14 2 3 3 16 9 47% 30 4 6 6 34 19 100

Southern # 29 12 22 51 62 24 200% 15 6 11 26 31 12 100

Eastern # 8 6 2 12 28 17 73% 11 8 3 16 38 23 100

Southwestern # 7 2 3 11 14 6 43% 16 5 7 26 33 14 100

Central # 17 15 16 38 54 22 162% 10 9 10 23 33 14 100





Table B-34. Hours on call by physician specialty 32. What is your primary specialty?30. In a typical week, how many hours do you spend on call?

Physician specialty No on-call

hours1–10

hours/week11–20

hours/week21–30

hours/week

More than 30

hours/weekAlways on

call TotalPrimary care # 139 151 166 240 255 106 1057

% 13 14 16 23 24 10 100

Medical specialties # 64 73 73 84 129 77 500% 13 15 15 17 26 15 100

Surgical specialties # 20 10 21 51 116 38 256% 8 4 8 20 45 15 100

Hospital-based # 144 44 61 50 59 9 367% 39 12 17 14 16 2 100

Other # 60 20 8 8 24 62 182% 33 11 4 4 13 34 100


Table B-35. Hours on call by urban or rural setting33b. Setting and ownership30. In a typical week, how many hours do you spend on call?

Urban or rural regionNo on-call

hours1–10

hours/week11–20

hours/week21–30

hours/week

More than 30

hours/weekAlways on

call TotalUrban # 242 201 220 259 298 156 1376

% 18 15 16 19 22 11 100

Rural # 84 31 35 113 185 79 527% 16 6 7 21 35 15 100






Table B-36. Importance of issues by practice location

33b. Setting and ownership39. Rate the importance of each of the following issues to you.

Practice locationVery

importantSomewhat important

Not important

Not applicable Total Practice location

Very important

Somewhat important

Not important

Not applicable Total

Portland Metro # 345 268 213 2 828 Portland Metro # 534 177 110 3 824% 42 32 26 0 100 % 65 21 13 0 100

Mid-Willamette valley # 175 156 86 — 417 Mid-Willamette valley # 278 89 44 – 411% 42 37 21 — 100 % 68 22 11 – 100

Northwestern # 19 21 9 — 49 Northwestern # 36 6 7 – 49% 39 43 18 — 100 % 73 12 14 – 100

Southern # 52 93 58 — 203 Southern # 156 32 15 – 203% 26 46 29 — 100 % 77 16 7 – 100

Eastern # 24 24 22 — 70 Eastern # 56 12 4 – 72% 34 34 31 — 100 % 78 17 6 – 100

Southwestern # 10 20 12 — 42 Southwestern # 33 6 3 – 42% 24 48 29 — 100 % 79 14 7 – 100

Central # 62 62 42 — 166 Central # 127 31 7 – 165% 37 37 25 — 100 % 77 19 4 – 100

Chi-square value = 37.726 p<0.010 Chi-square value = 33.120 p<0.016Note: — indicates no responses in the category. Note: — indicates no responses in the category.

Medicare reimbursementElectronic medical records





Very important

Somewhat important

Not important


Very important

Somewhat important

Not important



Mid-Willamette Valley # 296 102 21 — 419 Mid-Willamette Valley # 207 163 44 — 414% 71 24 5 — 100 % 50 39 11 — 100

Northwestern # 33 11 5 — 49 Northwestern # 25 21 3 — 49% 67 22 10 — 100 % 51 43 6 — 100

Southern # 155 39 8 — 202 Southern # 106 71 24 — 201% 77 19 4 — 100 % 53 35 12 — 100

Eastern # 54 13 3 — 70 Eastern # 37 27 6 — 70% 77 19 4 — 100 % 53 39 9 — 100

Southwestern # 32 8 2 — 42 Southwestern # 16 18 8 — 42% 76 19 5 — 100 % 38 43 19 — 100

Central # 128 35 3 — 166 Central # 94 57 15 — 166% 77 21 2 — 100 % 57 34 9 — 100


Pharmaceutical costsOverhead cost





Very important

Somewhat important

Not important


Very important

Somewhat important

Not important






Eastern # 41 23 6 — 70 Eastern # 54 13 4 —% 59 33 9 — 100 % 76 18 6 — 71

100Southwestern # 22 15 6 — 43 Southwestern # 27 13 2 —

% 51 35 14 — 100 % 64 31 5 — 42100

Central # 94 58 11 — 163 Central # 119 40 7 —% 58 36 7 — 100 % 72 24 4 — 166

Chi-square value = 14.519 p<0.695 Chi-square value = 17.746 p<0.472Note: — indicates no responses in the category. Note: — indicates no responses in the category. 100

Cost/availability of liability insuranceStress and burnout





Very important

Somewhat important

Not important


Very important

Somewhat important

Not important



Mid-Willamette Valley # 198 147 69 — 414 Mid-Willamette Valley # 44 167 201 1 413% 48 36 17 — 100 % 11 40 49 0 100



Eastern # 44 20 7 — 71 Eastern # 8 20 43 — 71% 62 28 10 — 100 % 11 28 61 — 100


Central # 70 67 28 — 165 Central # 9 54 101 — 164% 42 41 17 — 100 % 5 33 62 — 100


Cost of translation servicesCall coverage





Very important

Somewhat important

Not important


Very important

Somewhat important

Not important






Eastern # 37 29 4 — 70 Eastern # 57 13 1 — 71% 53 41 6 — 100 % 80 18 1 — 100


Central # 91 65 10 — 166 Central # 116 40 10 — 166% 55 39 6 — 100 % 70 24 6 — 100


Medicaid/OHP reimbursementCoverage for uninsured





Very important

Somewhat important

Not important


Very important

Somewhat important

Not important



Mid-Willamette Valley # 257 131 26 — 414 Mid-Willamette Valley # 154 206 55 1 416% 62 32 6 — 100 % 37 50 13 0 100



Eastern # 44 26 1 — 71 Eastern # 26 29 16 — 71% 62 37 1 — 100 % 37 41 23 — 100


Central # 111 51 4 — 166 Central # 57 83 24 — 164% 67 31 2 — 100 % 35 51 15 — 100


Commercial insurance reimbursement Recruitment of qualified non-physician staff





Portland MetroVery


Not important

Not applicable Total Portland Metro

Very important

Somewhat important

Not important


# 155 429 239 1 824 # 258 309 256 1 824% 19 52 29 0 100 % 31 38 31 0 100

Mid-Willamette Valley Mid-Willamette Valley# 62 214 139 1 416 # 161 178 75 1 415% 15 51 33 0 100 % 39 43 18 0 100

Northwestern Northwestern# 9 22 18 — 49 # 20 20 9 — 49% 18 45 37 — 100 % 41 41 18 — 100

Southern Southern# 12 89 101 — 202 # 84 75 43 — 202% 6 44 50 — 100 % 42 37 21 — 100

Eastern Eastern# 8 30 33 — 71 # 28 30 11 — 69% 11 42 46 — 100 % 41 43 16 — 100

Southwestern Southwestern# 2 20 21 — 43 # 18 16 8 — 42% 5 47 49 — 100 % 43 38 19 — 100

Central Central# 22 82 61 — 165 # 72 51 43 — 166% 13 50 37 — 100 % 43 31 26 — 100


Recruitment of physiciansProviding culturally appropriate services





Portland MetroVery


Not important


Very important

Somewhat important

Not important


# 358 338 128 1 825 # 189 377 250 1 817% 43 41 16 0 100 % 23 46 31 0 100

Mid-Willamette Valley Mid-Willamette Valley# 183 185 50 — 418 # 91 192 127 — 410% 44 44 12 — 100 % 22 47 31 — 100



Eastern Eastern# 33 36 2 — 71 # 12 40 19 — 71% 46 51 3 — 100 % 17 56 27 — 100

Southwestern Southwestern# 16 18 8 — 42 # 10 19 13 — 42% 38 43 19 — 100 % 24 45 31 — 100

Central Central# 88 61 17 — 166 # 49 76 39 — 164% 53 37 10 — 100 % 30 46 24 — 100


Medicare prescription drug benefitTimeliness of health plan payment





Portland MetroVery


Not important Total Portland Metro

Very important

Somewhat important

Not important


# 514 257 53 824 # 141 290 387 1 819% 62 31 6 100 % 17 35 47 0 100

Mid-Willamette Valley Mid-Willamette Valley# 253 132 31 416 # 78 183 154 1 416% 61 32 7 100 % 19 44 37 0 100

Northwestern Northwestern# 34 12 2 48 # 9 24 14 — 47% 71 25 4 100 % 19 51 30 — 100

Southern Southern# 121 61 19 201 # 21 83 99 — 203% 60 30 9 100 % 10 41 49 — 100

Eastern Eastern# 43 23 5 71 # 8 32 31 — 71% 61 32 7 100 % 11 45 44 — 100

Southwestern Southwestern# 21 17 4 42 # 7 17 18 — 42% 50 40 10 100 % 17 40 43 — 100

Central Central# 89 61 15 165 # 15 75 76 — 166% 54 37 9 100 % 9 45 46 — 100

Chi-square value = 10.335 p<0.587 Chi-square value = 33.331 p<0.015Note: — indicates no responses in the category.

Patient safety Electronic prescribing





Portland MetroVery


Not important


Very important

Somewhat important

Not important


# 365 366 95 1 827 # 197 457 166 1 821% 44 44 11 0 100 % 24 56 20 0 100

Mid-Willamette Valley Mid-Willamette Valley# 193 182 38 1 414 # 114 227 72 1 414% 47 44 9 0 100 % 28 55 17 0 100



Eastern Eastern# 39 25 7 — 71 # 23 37 12 — 72% 55 35 10 — 100 % 32 51 17 — 100

Southwestern# 24 11 7 — 42 Southwestern # 7 28 7 — 42% 57 26 17 — 100 % 17 67 17 — 100

Central# 76 74 15 — 165 Central # 39 103 24 — 166% 46 45 9 — 100 % 23 62 14 — 100


Hospital/medical staff issuesGovernment regulation





Portland MetroVery


Not important


# 344 293 184 1 822% 42 36 22 0 100

Mid-Willamette Valley# 192 170 51 1 414% 46 41 12 0 100

Northwestern# 25 16 8 — 49% 51 33 16 — 100

Southern# 104 72 25 — 201% 52 36 12 — 100

Eastern# 39 25 6 — 70% 56 36 9 — 100

Southwestern# 23 14 5 — 42% 55 33 12 — 100

Central# 71 70 25 — 166% 43 42 15 — 100


Retention of physicians



32. What is your primary specialty?39. Rate the importance of each of the following issues to you.

Physician specialtyVery


Not important

Not applicable Total Physician specialty

Very important

Somewhat important

Not important


Primary care # 457 360 238 — 1055 Primary care # 682 230 134 — 1046% 43 34 23 — 100 % 65 22 13 — 100

Medical specialties # 202 177 128 — 507 Medical specialties # 396 85 28 1 510% 40 35 a — 100 % 78 17 5 0 100

Surgical specialties # 74 108 71 — 253 Surgical specialties # 199 40 13 — 252% 29 43 28 — 100 % 79 16 5 — 100

Hospital-based # 180 135 58 — 373 Hospital-based # 290 70 13 — 373% 48 36 16 — 100 % 78 19 3 — 100

Other # 57 53 71 2 183 Other # 60 51 66 2 179% 31 29 39 1 100 % 34 28 37 1 100

Chi-square value =80.594 p<0.0001 Chi-square value = 234.264 p<0.0001Note: — indicates no responses in the category. Note: — indicates no responses in the category.

Electronic medical records

Table B-37. Importance of issues by physician specialty

Medicare reimbursement







Not important


Very important

Somewhat important

Not important



Medical specialties # 393 85 26 1 505 Medical specialties # 259 203 39 1 502% 78 17 5 0 100 % 52 40 8 0 100



Other # 97 59 24 — 181 Other # 103 58 19 1 181% 54 33 13 — 100 % 57 32 10 1 100


Pharmaceutical costsOverhead cost







Not important


Very important

Somewhat important

Not important






Other # 98 62 19 2 181 Other # 87 67 28 1 183% 54 34 10 1 100 % 48 37 15 1 100


Stress and burnout Cost/availability of liability insurance







Not important


Very important

Somewhat important

Not important






Other # 50 60 71 1 182 Other # 12 41 126 2 181% 27 33 39 1 100 % 7 23 70 1 100


Call coverage Cost of translation services







Not important


Very important

Somewhat important

Not important



Medical specialties # 274 190 41 — 505 Medical specialties # 318 148 41 — 507% 54 38 8 — 100 % 63 29 8 — 100



Other # 86 65 30 2 183 Other # 71 50 58 2 181% 47 36 16 1 100 % 39 28 32 1 100


Medicaid/OHP reimbursementCoverage for uninsured







Not important


Very important

Somewhat important

Not important



Medical specialties # 334 144 27 — 505 Medical specialties # 212 228 61 1 502% 66 29 5 — 100 % 42 45 12 0 100



Other # 94 55 30 1 180 Other # 53 65 64 1 183% 52 31 17 1 100 % 29 36 35 1 100


Recruitment of qualified non-physician staffCommercial insurance reimbursement







Not important


Very important

Somewhat important

Not important






Other # 43 81 57 1 182 Other # 49 55 77 1 182% 24 45 31 1 100 % 27 30 42 1 100


Providing culturally appropriate services Recruitment of physicians







Not important


Very important

Somewhat important

Not important



Medical specialties # 263 201 43 — 507 Medical specialties # 133 257 113 — 503% 52 40 8 — 100 % 26 51 22 — 100



Other # 67 70 43 1 181 Other # 44 61 72 1 178% 37 39 24 1 100 % 25 34 40 1 100

Chi-square value =67.044 p<0.0001 Chi-square value = 109.620 p<0.0001Note: — indicates no responses in the category. Note: — indicates no responses in the category.

Timeliness of health plan payment Medicare prescription drug benefit







Not important Total Physician specialty

Very important

Somewhat important

Not important


Primary care # 619 357 74 1050 Primary care # 214 438 398 — 1050% 59 34 7 100 % 20 42 38 — 100

Medical specialties # 322 150 34 506 Medical specialties # 75 233 196 1 505% 64 30 7 100 % 15 46 39 0 100

Surgical specialties # 146 83 23 252 Surgical specialties # 16 107 130 — 253% 58 33 9 100 % 6 42 51 — 100

Hospital-based # 248 103 22 373 Hospital-based # 36 130 204 — 370% 66 28 6 100 % 10 35 55 — 100

Other # 119 53 11 183 Other # 35 43 101 1 180% 65 29 6 100 % 19 24 56 1 100

Chi-square value = 11.437 p<0.178 Chi-square value = 96.465 p<0.0001Note: — indicates no responses in the category.

Patient safety Electronic prescribing







Not important


Very important

Somewhat important

Not important


Primary care # 448 478 120 — 1046 Primary care # 235 630 187 — 1,052% 43 46 11 — 100 % 22 60 18 — 100




Other # 70 89 21 1 181 Other # 40 55 86 1 182% 39 49 12 1 100 % 22 30 47 1 100


Government regulation Hospital/medical staff issues







Not important


Primary care # 463 402 183 — 1048% 44 38 17 — 100


Surgical specialties # 126 92 35 — 253% 50 36 14 — 100

Hospital-based # 215 123 36 — 374% 57 33 10 — 100

Other # 59 57 63 1 180% 33 32 35 1 100


Retention of physicians



Table B-38. Anticipated changes in upcoming two years by physician specialty 32. What is your primary specialty?17. Please indicate whether you anticipate taking the following actions in your practice in the next two years.

Physician specialtyDefinitely

will do Might doNot

anticipated TotalPrimary care # 27 67 846 940

% 3 7 90 100



Hospital-based # 8 13 235 256% 3 5 92 100

Other # 9 17 137 163% 6 10 84 100



will do Might doNot


% 7 23 70 100



Hospital-based # 6 27 218 251% 2 11 87 100

Other # 12 26 104 142% 8 18 73 100


Stop all patient care






will do Might doNot


% 6 14 79 100



Hospital-based # 11 23 215 249% 4 9 86 100

Other # 8 7 125 140% 6 5 89 100



will do Might doNot


% 3 10 87 100



Hospital-based # 10 19 211 240% 4 8 88 100

Other # 8 9 121 138% 6 7 88 100








will do Might doNot


% 5 23 72 100



Hospital-based # 28 55 195 278% 10 20 70 100

Other # 17 45 98 160% 11 28 61 100



will do Might doNot


% 11 25 64 100



Hospital-based # 23 39 205 267% 9 15 77 100

Other # 9 27 112 148% 6 18 76 100



Increases referral of complex cases





will do Might doNot


% 3 10 88 100



Hospital-based # 7 30 251 288% 2 10 87 100

Other # 3 12 142 157% 2 8 90 100



will do Might doNot


% 2 12 86 100



Hospital-based # 8 48 233 289% 3 17 81 100

Other # 2 16 143 161% 1 10 89 100








will do Might doNot


% 2 9 89 100



Hospital-based # 6 12 244 262% 2 5 93 100

Other # 1 21 127 149% 1 14 85 100



will do Might doNot


% 3 11 86 100



Hospital-based # 15 40 252 307% 5 13 82 100

Other # 5 19 140 164% 3 12 85 100


Retire






will do Might doNot


% 6 20 75 100



Hospital-based # 35 49 192 276% 13 18 70 100

Other # 2 14 128 144% 1 10 89 100





Table B-39. Anticipated changes in upcoming two years by practice location33b. Setting and ownership17. Please indicate whether you anticipate taking the following actions in your practice in the next two years.

Practice locationDefinitely

will do Might doNot

anticipated Total Practice locationDefinitely

will do Might doNot

anticipated TotalPortland Metro # 21 53 634 708 Portland Metro # 55 154 490 699

% 3 7 90 100 % 8 22 70 100

Mid-Willamette Valley # 12 24 324 360 Mid-Willamette Valley # 19 67 266 352% 3 7 90 100 % 5 19 76 100

Northwestern # 3 2 35 40 Northwestern # 4 7 27 38% 8 5 88 100 % 11 18 71 100

Southern # 8 10 160 178 Southern # 10 50 114 174% 4 6 90 100 % 6 29 66 100

Eastern # 2 5 54 61 Eastern # 3 12 46 61% 3 8 89 100 % 5 20 75 100

Southwestern # 3 2 33 38 Southwestern # 2 5 29 36% 8 5 87 100 % 6 14 81 100

Central # 4 15 119 138 Central # 17 32 91 140% 3 11 86 100 % 12 23 65 100

Chi-square value = 9.342 p<0.673 Chi-square value = 17.969 p<0.117

Stop all patient care Stop services to specific groups





will do Might doNot


will do Might doNot


% 6 12 82 100 % 5 8 87 100




Eastern # 2 13 44 59 Eastern # 3 7 48 58% 3 22 75 100 % 5 12 83 100


Central # 15 26 100 141 Central # 7 12 107 126% 11 18 71 100 % 6 10 85 100


Stop providing certain services Start providing certain services





will do Might doNot


will do Might doNot


% 7 23 69 100 % 11 20 70 100




Eastern # 13 24 29 66Eastern # 3 16 46 65 % 20 36 44 100

% 5 25 71 100Southwestern # 5 6 24 35

Southwestern # 3 11 23 37 % 14 17 69 100% 8 30 62 100

Central # 13 42 84 139Central # 15 34 95 144 % 9 30 60 100

% 10 24 66 100Chi-square value = 31.593 p<0.002


Increases referral of complex casesReduce patient care hours





will do Might doNot


will do Might doNot


% 2 9 88 100 % 1 10 89 100


Northwestern # — 5 32 37 Northwestern # — 10 27 37% — 14 86 100 % — 27 73 100


Eastern # 1 13 50 64 Eastern # — 15 48 63% 2 20 78 100 % — 24 76 100

Southwestern # — 2 34 36 Southwestern # — 8 28 36% — 6 94 100 % — 22 78 100

Central # 4 15 124 143 Central # 5 25 117 147% 3 10 87 100 % 3 17 80 100


Relocate practice within state Relocate practice to another state





will do Might doNot


will do Might doNot


% 3 10 88 100 % 4 13 83 100




Eastern # 2 14 46 62 Eastern # 2 11 52 65% 3 23 74 100 % 3 17 80 100


Central # 5 19 113 137 Central # 4 20 120 144% 4 14 82 100 % 3 14 83 100


Close or sell practice Retire





will do Might doNot

anticipated TotalPortland Metro # 58 129 532 719

% 8 18 74 100


Northwestern # 1 9 27 37% 3 24 73 100

Southern # 20 34 126 180% 11 19 70 100

Eastern # 7 11 45 63% 11 17 71 100

Southwestern # — 5 32 37% — 14 86 100

Central # 10 37 96 143% 7 26 67 100





Table B-40. Satisfaction with medical career in past 12 months by physician specialty 32. What is your primary specialty?9. How satisfied have you been with your medical career in the last 12 months?


satisfiedSomewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied Total

Primary care # 340 475 46 156 49 1066% 32 45 4 15 5 100



Hospital-based # 147 138 33 37 19 374% 39 37 9 10 5 100

Other # 73 74 8 23 6 184% 40 40 4 13 3 100


Satisfaction in past 12 months



Table B-41. Satisfaction with medical career in past 12 months by length of licensure

6. How long have you had a medical license in any state, including Oregon?9. How satisfied have you been with your medical career in the last 12 months?

Length of licensureVery





Less than 2 years # 14 11 2 2 1 30% 47 37 7 7 3 100

2-5 years # 69 96 13 16 7 201% 34 48 6 8 3 100

6-10 years # 112 158 16 54 19 359% 31 44 4 15 5 100

11-20 years # 220 332 41 93 30 716% 31 46 6 13 4 100

More than 20 years # 404 401 66 175 57 1103% 37 36 6 16 5 100





Table B-42. Satisfaction with medical career in past 12 months by practice size

29. What is the size of your primary practice, that is, the practice in which you spend the most time?9. How satisfied have you been with your medical career in the last 12 months?

Practice sizeVery





Solo practice # 185 216 28 107 37 573% 32 38 5 19 6 100

Small group practice (2-4 physicians) # 144 243 33 84 19 523% 28 46 6 16 4 100

Medium group practice (5-9 physicians) # 166 202 30 52 21 471% 35 43 6 11 4 100



Table B-43. Satisfaction with medical career in past 12 months by rural/urban33b. Setting and ownership9. How satisfied have you been with your medical career in the last 12 months?

RegionVery





Rural # 150 219 39 90 38 536% 28 41 7 17 7 100

Urban # 495 583 77 182 56 1393% 36 42 6 13 4 100






Table B-44. Satisfaction with medical career in past 12 months by practice location33b. Setting and ownership9. How satisfied have you been with your medical career in the last 12 months?






Portland Metro # 276 355 50 115 39 835% 33 43 6 14 5 100


Northwestern # 12 19 5 10 3 49% 24 39 10 20 6 100

Southern # 72 80 14 29 10 205% 35 39 7 14 5 100

Eastern # 15 34 4 12 8 73% 21 47 5 16 11 100

Southwestern # 13 19 3 5 3 43% 30 44 7 12 7 100

Central # 55 58 13 28 11 165% 33 35 8 17 7 100





Table B-45. Satisfaction with medical career in past 12 months by practice setting

33b. Setting and ownership9. How satisfied have you been with your medical career in the last 12 months?

Practice settingVery





Hospital # 362 427 62 142 53 1046% 35 41 6 14 5 100

Clinic, private, for profit # 413 553 81 219 62 1328% 31 42 6 16 5 100

Clinic, private, not for profit # 96 118 12 42 8 276% 35 43 4 15 3 100

Clinic, public # 39 50 5 16 6 116% 34 43 4 14 5 100

Other # 29 30 3 8 7 77% 38 39 4 10 9 100




Table B-46. Satisfaction with medical career in past 12 months by ownership or employment status

33c. Employment9. How satisfied have you been with your medical career in the last 12 months?

OwnershipVery








Volunteer # 7 1 2 1 — 11% 64 9 18 9 — 100

Other # 16 17 1 4 3 41% 39 41 2 10 7 100





Table B-47. Satisfaction with medical career overall by physician specialty

32. What is your primary specialty?9. How satisfied have you been with your medical career overall?

Physican specialty Very





Primary care # 500 416 38 89 18 1061% 47 39 4 8 2 100



Hospital-based # 198 132 20 17 8 375% 53 35 5 5 2 100

Other # 92 73 5 9 6 185% 50 39 3 5 3 100


Satisfaction with medical career overall



Table B-48. Satisfaction with medical career overall by length of licensure6. How long have you had a medical license in any state, including Oregon?9. How satisfied have you been with your medical career overall?

Length of licensureVery





Less than 2 years # 18 8 1 3 — 30% 60 27 3 10 — 100

2–5 years # 93 80 13 11 3 200% 47 40 7 6 2 100

6–10 years # 133 165 14 36 10 358% 37 46 4 10 3 100

11–20 years # 290 316 31 65 14 716% 41 44 4 9 2 100

More than 20 years # 658 338 22 63 20 1101% 60 31 2 6 2 100





Table B-49. Satisfaction with medical career overall by practice size

29. What is the size of your primary practice, that is, the practice in which you spend the most time?9. How satisfied have you been with your medical career overall?

Practice sizeVery





Solo practice # 289 206 14 50 15 574% 50 36 2 9 3 100








Table B-50. Satisfaction with medical career overall by practice location

33b. Setting and ownership9. How satisfied have you been with your medical career overall?






Portland Metro # 425 308 28 58 16 835% 51 37 3 7 2 100


Northwestern # 17 24 2 5 1 49% 35 49 4 10 2 100

Southern # 108 76 5 13 3 205% 53 37 2 6 1 100

Eastern # 22 38 3 9 1 73% 30 52 4 12 1 100

Southwestern # 15 21 1 6 — 43% 35 49 2 14 — 100

Central # 78 65 3 13 5 164% 48 40 2 8 3 100





Table B-51. Satisfaction with medical career overall by urban/rural33b. Setting and ownership9. How satisfied have you been with your medical career overall?

RegionVery





Rural # 230 226 16 51 11 534% 43 42 3 10 2 100

Urban # 722 514 43 90 24 1393% 52 37 3 6 2 100


33b. Setting and ownership9. How satisfied have you been with your medical career overall?

Practice settingVery





Hospital # 508 403 34 78 20 1043% 49 39 3 7 2 100

Clinic, private, for profit # 647 508 39 110 22 1326% 49 38 3 8 2 100


Clinic, public # 58 38 7 11 2 116% 50 33 6 9 2 100

Primary practice setting--other # 42 23 2 7 2 76% 55 30 3 9 3 100



Table B-52. Satisfaction within medical career overall by practice setting



Table B-53. Satisfaction with medical career overall by ownership or employment status33c. Employment9. How satisfied have you been with your medical career overall?

Employment roleVery








Volunteer # 5 4 — 1 1 11% 45 36 — 9 9 100

Other # 26 12 1 1 1 41% 63 29 2 2 2 100





TableB-54. Greatest source of professional satisfaction by physician specialty32. What is your primary specialty?11. What is the greatest source of your professional satisfaction?

Physician specialty IncomeIntellectual challenge

Patient relationships

Practice environment Other Total

Primary care # 40 199 660 107 24 1030% 4 19 64 10 2 100



Hospital-based # 50 129 68 99 14 360% 14 36 19 28 4 100

Other # 10 47 93 24 6 180% 6 26 52 13 3 100


Greatest source of professional satisfaction



Table B-55. Greatest source of professional satisfaction by practice location33b. Setting and ownership11. What is the greatest source of your professional satisfaction?

Practice location IncomeIntellectual challenge



Portland Metro # 45 208 429 102 20 804% 6 26 53 13 2 100


Northwestern # 7 8 27 5 1 48% 15 17 56 10 2 100

Southern # 14 52 102 27 7 202% 7 26 50 13 3 100

Eastern # 2 17 39 8 3 69% 3 25 57 12 4 100

Southwestern # 1 7 25 8 1 42% 2 17 60 19 2 100

Central # 5 42 83 25 7 162% 3 26 51 15 4 100





Table B-56. Greatest source of professional satisfaction by length of licensure

6. How long have you had a medical license in any state, including Oregon?11. What is the greatest source of your professional satisfaction?

Length of licensure IncomeIntellectual challenge



Less than 2 years # 1 4 15 5 1 26% 4 15 58 19 4 100

2–5 years # 17 44 100 31 4 196% 9 22 51 16 2 100

6–10 years # 32 77 170 58 10 347% 9 22 49 17 3 100

11–20 years # 48 173 346 111 21 699% 7 25 49 16 3 100

More than 20 years # 46 275 585 115 42 1063% 4 26 55 11 4 100





Table B-57. Greatest source of prfessional satisfaction by practice size

29. What is the size of your primary practice, that is, the practice in which you spend the most time?11. What is the greatest source of your professional satisfaction?

Practice size IncomeIntellectual challenge



Solo practice # 36 115 330 58 22 561% 6 20 59 10 4 100





33b. Setting and ownership11. What is the greatest source of your professional satisfaction?

Urban/rural region IncomeIntellectual challenge



Rural # 27 98 298 80 21 524% 5 19 57 15 4 100

Urban # 78 376 682 169 45 1350% 6 28 51 13 3 100




Table B-58. Greatest source of professional satisfaction by urban/rural



33b. Setting and ownership11. What is the greatest source of your professional satisfaction?

IncomeIntellectual challenge



Hospital # 65 300 436 165 37 1003% 6 30 43 16 4 100

63 272 768 151 34 1288% 5 21 60 12 3 100


Clinic, public # 3 40 47 13 9 112% 3 36 42 12 8 100

Other # 6 7 35 15 10 73% 8 10 48 21 14 100


Clinic, private, for profit

Practice setting


Table B-59. Greatest source of professional satisfaction by practice setting



33c. Employment11. What is the greatest source of your professional satisfaction?

Employment role IncomeIntellectual challenge






Volunteer # — 1 3 1 — 5% — 20 60 20 — 100

Other # — 8 14 3 5 30% — 27 47 10 17 100


Table B-60. Greatest source of professional satisfaction by ownership of employment status



Section 3. Acceptance of payers


32. What is your primary specialty?

Physician specialty Accept allLimit

acceptance Accept none Total Physician specialty Accept allLimit

acceptance Accept none TotalPrimary care # 764 186 29 979 Primary care # 518 282 126 926

% 78 19 3 100 % 56 30 14 100

Medical specialties # 418 50 4 472 Medical specialties # 418 36 8 462% 89 11 1 100 % 90 8 2 100

Surgical specialties # 204 35 4 243 Surgical specialties # 215 19 7 241% 84 14 2 100 % 89 8 3 100

Hospital-based # 311 10 1 322 Hospital-based # 308 11 1 320% 97 3 0 100 % 96 3 0 100

Other # 87 69 11 167 Other # 61 38 53 152% 52 41 7 100 % 40 25 35 100


Table B-61. Acceptance of payer type by physician specialty

Commercial Medicare

15. For each of the payers listed below, please indicate whether your office accepts all, limits acceptance, or accepts none of the following payers.



32. What is your primary specialty?Table B-61. Acceptance of payer type by physician specialty





% 42 41 17 100 % 41 38 21 100




Other # 42 32 76 150 Other # 48 33 73 154% 28 21 51 100 % 31 21 47 100


Medicaid FFS Medicaid managed care








% 60 21 19 100 % 53 26 21 100




Other # 49 31 67 147 Other # 49 40 62 151% 33 21 46 100 % 32 26 41 100

Chi-square value =315.812 p<0.0001 Chi-square value = 335.461 p<0.0001

TRICARE/CHAMPUS Workers' comp






acceptance Accept none TotalPrimary care # 551 341 50 942

% 58 36 5 100



Hospital-based # 298 15 5 318% 94 5 2 100

Other # 58 73 23 154% 38 47 15 100


Uninsured



33b. Setting and ownership

Practice location Accept allLimit

acceptance Accept none Total Practice location Accept allLimit

acceptance Accept none TotalPortland Metro # 572 165 27 764 Portland Metro # 497 148 93 738

% 75 22 4 100 % 67 20 13 100




Eastern # 67 3 1 71 Eastern # 57 8 5 70% 94 4 1 100 % 81 11 7 100

Southwestern # 32 9 — 41 Southwestern # 34 6 — 40% 78 22 — 100 % 85 15 — 100

Central # 136 18 4 158 Central # 113 28 10 151% 86 11 3 100 % 75 19 7 100

Chi-square value = 38.854 p<0.0001 Chi-square value = 22.583 p<0.031Note:—– indicates no responses in the category. Note: — indicates no responses in the category.

Table B-62. Acceptance of patients for each payer type by practice location

Commercial Medicare

15. For each of the payers listed beow, please indicate whether your office accepts all, limits acceptance, or accepts none of the following payers.



33b. Setting and ownershipTable B-62. Acceptance of patients for each payer type by practice location





% 46 32 22 100 % 46 30 24 100




Eastern # 55 11 4 70 Eastern # 44 15 7 66% 79 16 6 100 % 67 23 11 100


Central # 97 36 20 153 Central # 97 36 18 151% 63 24 13 100 % 64 24 12 100


Medicaid FFS Medicaid managed care








% 61 15 23 100 % 59 21 20 100




Eastern # 55 8 5 68 Eastern # 52 9 10 71% 81 12 7 100 % 73 13 14 100


Central # 123 17 14 154 Central # 113 18 17 148% 80 11 9 100 % 76 12 11 100


TRICARE/CHAMPUS Workers' comp






acceptance Accept none TotalPortland Metro # 427 248 51 726

% 59 34 7 100


Northwestern # 34 12 — 46% 74 26 — 100

Southern # 125 51 9 185% 68 28 5 100

Eastern # 57 12 1 70% 81 17 1 100

Southwestern # 29 12 — 41% 71 29 — 100

Central # 120 31 5 156% 77 20 3 100


Uninsured


Section 4. Specialty care


Table B-63. Distribution of physicians who currently deliver babies (N=226)

1. What is your gender?33b. Setting and ownership32. What is your primary specialty?6. How long have you had a medical license in any state, including Oregon?

# %Ob/gyn statusMaternity care, ob/gyn 121 54Maternity care, not ob/gyn 105 46

GenderFemale 109 48Male 117 52

Practice locationPortland Metro 83 46Mid-Willamette Valley 37 20Northwestern 5 3Southern 14 8Eastern 14 8Southwestern 7 4Central 22 12

Physician specialtyEmergency Medicine 4 2Family Practice 100 44OB/GYN 121 54Urology 1 0

Length of licensureLess than 2 years 10 42–5 years 40 186–10 years 49 2211–20 years 65 29More than 20 years 62 27

38. If you have practiced, or currently practice maternity care, are you currently delivering babies?



Table B-64. Maternity care procedures performed by practice location33b. Setting and ownership38b. Does your maternity care practice include the following procedures?

Practice location PerformDo not perform Total Perform

Do not perform Total Perform

Do not perform Total

Portland Metro # 52 24 76 53 20 73 63 5 68% 68 32 100 73 27 100 93 7 100

Mid-Willamette Valley # 29 7 36 18 15 33 34 — 34% 81 19 100 55 45 100 100 — 100

Northwestern # 1 3 4 1 3 4 2 1 3% 25 75 100 25 75 100 67 33 100

Southern # 11 — 11 4 8 12 12 — 12% 100 — 100 33 67 100 100 — 100

Eastern # 11 1 12 2 11 13 12 — 12% 92 8 100 15 85 100 100 — 100

Southwestern # 5 2 7 4 3 7 6 1 7% 71 29 100 57 43 100 86 14 100

Central # 18 5 23 4 18 22 23 — 23% 78 22 100 18 82 100 100 — 100

Note: – indicates no responses in the category.Chi-square value = 13.354 p<0.038 Chi-square value = 32.494 p<1.312 Chi-square value = 12.727 p<0.048

High-risk pregnancies or deliveries VBAC

Deliveries for Medicaid women



Table B-64. Maternity care procedures performed by practice location33b. Setting and ownership38b. Does your maternity care practice include the following procedures?

Practice location PerformDo not perform Total Perform


Portland Metro # 61 6 67 43 24 67% 91 9 100 64 36 100

Mid-Willamette Valley # 35 — 35 26 9 35% 100 — 100 74 26 100

Northwestern # 1 2 3 1 2 3% 33 67 100 33 67 100

Southern # 11 1 12 9 3 12% 92 8 100 75 25 100

Eastern # 13 — 13 9 — 9% 100 — 100 100 — 100

Southwestern # 6 1 7 6 1 7% 86 14 100 86 14 100

Central # 23 — 23 12 10 22% 100 — 100 55 45 100

Note: – indicates no responses in the category.Chi-square value = 25.119 p<0.001 Chi-square value = 10.142 p<0.119

Assist in cesarean sections

Perform cesarean sections as

primary surgeon



Table B-65. Maternity care procedures performed by gender 1. What is your gender?38b. Does your maternity care practice include the following procedures?

Gender PerformDo not perform Total Perform



Female # 76 23 99 56 43 99 98 2 100% 77 23 100 57 43 100 98 2 100

Male # 82 32 114 52 56 108 94 9 103% 72 28 100 48 52 100 91 9 100

Chi-square value = 0.647 p<0.421 Chi-square value = 1.467 p<0.226 Chi-square value = 4.495 p<0.034

Gender PerformDo not perform Total Perform


Female # 93 6 99 59 38 97% 94 6 100 61 39 100

Male # 89 14 103 69 31 100% 86 14 100 69 31 100


Assist in Perform cesarean





Table B-66. Maternity care procedures performed by length of licensure 6. How long have you had a medical license in any state, including Oregon?38b. Does your maternity care practice include the following procedures?

Length of licensure PerformDo not perform Total Perform



Less than 2 years # 6 4 10 5 5 10 10 — 10

% 60 40 100 50 50 100 100 — 100

2–5 years # 25 12 37 14 23 37 35 2 37% 68 32 100 38 62 100 95 5 100

6–10 years # 34 9 43 24 20 44 42 1 43% 79 21 100 55 45 100 98 2 100

11–20 years # 49 13 62 32 27 59 56 3 59% 79 21 100 54 46 100 95 5 100

More than 20 years # 44 17 61 33 24 57 49 5 54% 72 28 100 58 42 100 91 9 100

Note: – indicates no responses in the category.Chi-square value = 3.327 p<0.505 Chi-square value = 4.014 p<0.404 Chi-square value = 2.943 p<0.567





Table B-66. Maternity care procedures performed by length of licensure 6. How long have you had a medical license in any state, including Oregon?38b. Does your maternity care practice include the following procedures?

Length of licensure PerformDo not perform Total Perform


Less than 2 years # 9 — 9 4 6 10

% 100 — 100 40 60 100

2–5 years # 34 3 37 15 21 36% 92 8 100 42 58 100

6–10 years # 39 4 43 29 13 42% 91 9 100 69 31 100

11–20 years # 53 6 59 41 17 58% 90 10 100 71 29 100

More than 20 years # 47 7 54 39 12 51% 87 13 100 76 24 100

Note: – indicates no responses in the category.Chi-square value = 1.712 p<0.789 Chi-square value = 15.435 p<0.004




Table B-67. Maternity care procedures performed by ob/gyn licensure 38. If you have practiced, or currently practice maternity care, are you currently delivering babies?32. What is your primary specialty?38b. Does your maternity care practice include the following procedures?

Ob/gyn licensure PerformDo not perform Total Perform



Not ob/gyn # 54 43 97 32 64 96 94 4 98% 56 44 100 33 67 100 96 4 100

Ob/gyn # 103 10 113 76 32 108 97 5 102% 91 9 100 70 30 100 95 5 100

Chi-square value = 34.823 p<0.0001 Chi-square value = 27.984 p<0.0001 Chi-square value = .078 p<0.780

Ob/gyn licensure PerformDo not perform Total Perform


Not ob/gyn # 88 11 99 28 66 94% 89 11 100 30 70 100

Ob/gyn # 93 7 100 99 1 100% 93 7 100 99 1 100







Table B-68. Distribution of physicians who are not currently delivering babies38. If you have practiced, or currently practice maternity care, are you currently delivering babies?32. What is your primary specialty?38d. How long ago did you stop delivering babies?

Length of licensure (N=306) # %Less than 2 years 2 1

2–5 years 20 7

6–10 years 43 14

11–20 years 78 25

More than 20 years 163 53

Region (N=234)Portland Metro 78 33

Mid-Willamette Valley 66 28

Northwestern 9 4

Southern 30 13

Eastern 14 6

Southwestern 7 3

Central 30 13

Gender (N=306)Female 89 29

Male 217 71



Table B-69. Time since stopping delivery of babies by ob/gyn licensure (N=303*)38. If you have practiced, or currently practice maternity care, are you currently delivering babies?32. What is your primary specialty?38d. How long ago did you stop delivering babies?

Ob/gyn licensure Within the last year

1 to 2 years ago

More than 2 years ago

Licensed ob/gyn # 3 8 28% 1 3 9

Not a licensed ob/gyn # 21 39 204% 7 13 67

*Does not include four ob/gyns who indicated that they do not currently deliver babies but did not specify when they stopped. Responses of the four ob/gyns are included in other anlyses of maternity care questions because the four respondents are trained maternity care providers.



Table B-70. Reasons for stopping delivery of babies by ob/gyn licensure

38. If you have practiced, or currently practice maternity care, are you currently delivering babies?32. What is your primary specialty?38e. Please rate the importance of each of the following factors in your decision to stop delivering babies.

Very important

Somewhat important

Not important Total

Very important

Somewhat important

Not important Total

Ob/gyn Ob/gyn# 1 6 13 20 # 19 12 5 36% 5 30 65 100 % 53 33 14 100

Non-ob/gyn # 36 27 73 136 Non-ob/gyn # 116 56 29 201% 26 20 54 100 % 58 28 14 100

Very important

Somewhat important

Not important Total

Very important

Somewhat important

Not important Total

Ob/gyn # 26 5 4 35 Ob/gyn # 11 8 10 29% 74 14 11 100 % 38 28 34 100


Lack of backup coverage for C-sections Time demands/personal life

Medical liability premiums Experience with lawsuits



Table B-70. Reasons for stopping delivery of babies by ob/gyn licensure

38. If you have practiced, or currently practice maternity care, are you currently delivering babies?32. What is your primary specialty?38e. Please rate the importance of each of the following factors in your decision to stop delivering babies.

Very important

Somewhat important

Not important Total

Very important

Somewhat important

Not important Total

Ob/gyn # 1 16 17 Ob/gyn # 7 14 10 31% 6 94 100 % 23 45 32 100


Very important

Somewhat important

Not important Total

Very important

Somewhat important

Not important Total

Ob/gyn # 6 5 14 25 Ob/gyn # 1 1 12 14% 24 20 56 100 % 7 7 86 100


Lack of interest Hospital privilege issues

Lack of demand Low level of reimbursement


Section 5. Liability insurance


Table B-71. Liability premium amount paid by ob/gyn licensure38. If you have practiced, or currently practice maternity care, are you currently delivering babies?32. What is your primary specialty?44. What is the annual premium amount for professional liability insurance that you are paying today?

Ob/gyn statusLess than

$5,000$5,000–$10,000

$10,000–$20,000

More than $20,000 Total Median Minimum Maximum

Ob/gyn # 1 8 11 89 109 38,000 3,000 250,000% 1 7 10 82 100

Not ob/gyn # 27 55 48 23 153 10,000 1,000 145,000% 18 36 31 15 100

Table B-72. Liability premium amount paid by physician specialty32. What is your primary specialty?44. What is the annual premium amount for professional liability insurance that you are paying today?

Physician specialtyLess than

$5,000$5,000–$10,000

$10,000–$20,000


Primary care # 68 177 109 116 470 10,000 500 250,000% 14 38 23 25 100

Medical specialties # 58 97 81 35 271 10,000 450 80,000% 21 36 30 13 100

Surgical specialties # 11 9 25 146 191 30,000 2,000 147,000% 6 5 13 76 100

Hospital-based # 9 36 93 30 168 14,000 2,000 135,000% 5 21 55 18 100

Other # 64 36 5 2 107 4,500 1,000 60,000% 60 34 5 2 100

Liability premium amount




Table B-73. Liability premium amount paid by hospital status33b. Setting and ownership32. What is your primary specialty?44. What is the annual premium amount for professional liability insurance that you are paying today?

Hospital statusLess than

$5,000$5,000–$10,000

$10,000–$20,000


Hospital-based, emergency medicine # 3 4 24 12 43 16,000 2,000 40,000

% 7 9 56 28 100

Hospital-based, not emergency medicine # 6 32 69 18 125 12,500 2,000 135,000

% 5 26 55 14 100

Not hospital-based # 201 319 220 299 1,039 10,000 450 250,000% 19 31 21 29 100

Table B-74. Liability premium amount paid by neurosurgery licensure 37. If you are a neurosurgeon, are you currently performing brain surgery and are you currently performing spine surgery?32. What is your primary specialty?44. What is the annual premium amount for professional liability insurance that you are paying today?

Neurosurgery licensureLess than

$5,000$5,000–$10,000

$10,000–$20,000


Neurosurgeon # 1 16 17 54,000 15,000 147,000% 6 94 100

Not neurosurgeon # 210 355 312 313 1,190% 18 30 26 26 100





Table B-75. Liability premium amount paid by pediatric specialty licensure32. What is your primary specialty?44. What is the annual premium amount for professional liability insurance that you are paying today?

Pediatric specialty licensure Less than

$5,000$5,000–$10,000

$10,000–$20,000


Pediatric # 33 33 23 6 95 7,320 1,000 176,704% 35 35 24 6 100

Chi-square value = 19.789 p<0.345 # 177 322 290 323 1,112 12,000 450 250,000

% 16 29 26 29 100

Table B-76. Liability premium amount paid by high-risk specialty licensure 32. What is your primary specialty?44. What is the annual premium amount for professional liability insurance that you are paying today?

High-risk specialty licensureLess than

$5,000$5,000–$10,000

$10,000–$20,000


High-risk specialty # 6 15 31 207 259 32,000 2,000 250,000% 2 6 12 80 100

Not high-risk specialty # 203 340 282 122 947 10,000 450 176,704% 21 36 30 13 100





Table B-77. Actions regarding concerns about the cost or availability of liability insurance coverage

ActionAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated TotalStop all direct patient care # 21 53 253 2,122 2,449

% 1 2 10 87 100

Stop services to specific groups # 180 93 406 1,701 2,380% 8 4 17 71 100

Stop providing certain services # 209 103 335 1,757 2,404% 9 4 14 73 100

Start providing certain services # 31 34 121 2,133 2,319% 1 1 5 92 100

Reduce patient care hours # 126 113 401 1,794 2,434% 5 5 16 74 100

Increase referral of complex cases # 267 282 466 1,434 2,449% 11 12 19 59 100

Relocate practice within state # 19 35 172 2,213 2,439% 1 1 7 91 100

Close or sell practice # 31 61 259 2,093 2,444% 1 2 11 86 100

Retire # 17 117 422 1,908 2,464% 1 5 17 77 100

Increase diagnostic procedures performed # 197 151 311 1,779 2,438% 8 6 13 73 100

Percentage taking or anticipating action

46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following actions.



Table B-78. Actions regarding liability by physician specialty32. What is your primary specialty?

Physician specialtyAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated Total Physician specialtyAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated TotalPrimary care # 11 19 109 943 1,082 Primary care # 98 39 179 740 1,056

% 1 2 10 87 100 % 9 4 17 70 100


Surgical specialties # 2 11 39 203 255 Surgical specialties # 32 24 63 130 249% 1 4 15 80 100 % 13 10 25 52 100

Hospital-based # 2 8 41 335 386 Hospital-based # 6 4 41 317 368% 1 2 11 87 100 % 2 1 11 86 100

Other # 3 6 15 168 192 Other # 20 11 14 145 190% 2 3 8 88 100 % 11 6 7 76 100



have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 11 4 13 72 100 % 1 2 6 91 100




Other # 12 8 14 158 192 Other # 4 3 6 174 187% 6 4 7 82 100 % 2 2 3 93 100



46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following Stop all direct patient care Stop services to specific groups



Table B-78. Actions regarding liability by physician specialty32. What is your primary specialty?46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following


have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 4 4 16 75 100 % 12 13 22 53 100




Other # 17 8 28 141 194 Other # 13 12 26 139 190% 9 4 14 73 100 % 7 6 14 73 100



have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 1 1 7 92 100 % 0 2 11 87 100




Other # 1 3 15 172 191 Other # 4 3 19 168 194% 1 2 8 90 100 % 2 2 10 87 100


Reduce patient care hours Increase referral of complex cases




Table B-78. Actions regarding liability by physician specialty32. What is your primary specialty?46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following Chi-square value = 19.789

Already have done

Definitely will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 1 2 11 86 100 % 0 4 16 80 100



Hospital-based # 4 9 28 343 384 Hospital-based # — 17 66 301 384% 1 2 7 89 100 % — 4 17 78 100

Other # 1 5 17 168 191 Other # 2 9 27 155 193% 1 3 9 88 100 % 1 5 14 80 100



have doneDefinitely

will do

May consider

doingNothing

anticipated TotalPrimary care # 83 73 156 765 1,077

% 8 7 14 71 100



Hospital-based # 33 23 41 285 382% 9 6 11 75 100

Other # 6 6 10 168 190% 3 3 5 88 100






Table B-79. Actions regarding liability by physician licensure32. What is your primary specialty?

Length of licensureAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated Total Length of licensureAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated TotalLess than 2 years # – – 2 44 46 Less than 2 years # 2 1 5 37 45

% – – 4 96 100 % 4 2 11 82 100

2–5 years # – 2 15 207 224 2–5 years # 13 4 46 158 221% – 1 7 92 100 % 6 2 21 71 100

6–10 years # 2 4 39 320 365 6–10 years # 26 18 64 246 354% 1 1 11 88 100 % 7 5 18 69 100

11–20 years # 4 10 76 622 712 11–20 years # 51 32 133 480 696% 1 1 11 87 100 % 7 5 19 69 100

More than 20 years # 14 37 120 924 1,095 More than 20 years # 87 38 157 777 1,059% 1 3 11 84 100 % 8 4 15 73 100

Note: — indicates no responses in the category. Chi-square value = 17.121 p<0.145Chi-square value = 26.884 p<0.008


have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing

anticipated TotalLess than 2 years # 1 3 3 39 46 Less than 2 years # – 2 2 42 46

% 2 7 7 85 100 % – 4 4 91 100

2–5 years # 12 10 37 160 219 2–5 years # 2 3 15 192 212% 5 5 17 73 100 % 1 1 7 91 100

6–10 years # 31 17 60 248 356 6–10 years # 4 7 20 308 339% 9 5 17 70 100 % 1 2 6 91 100

11–20 years # 46 28 110 518 702 11–20 years # 8 12 40 617 677% 7 4 16 74 100 % 1 2 6 91 100


Chi-square value = 28.793 p<0.004 Note: — indicates no responses in the category.Chi-square value = 12.428 p<0.412


46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following actions.Stop all direct patient care Stop services to specific groups



Table B-79. Actions regarding liability by physician licensure32. What is your primary specialty?46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following actions.


have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing

anticipated TotalLess than 2 years # – 1 7 38 46 Less than 2 years # – 6 5 35 46

% – 2 15 83 100 % – 13 11 76 100

2–5 years # 3 8 35 179 225 2–5 years # 17 24 57 128 226% 1 4 16 80 100 % 8 11 25 57 100

6–10 years # 9 13 59 282 363 6–10 years # 40 38 78 205 361% 2 4 16 78 100 % 11 11 22 57 100

11–20 years # 30 26 126 526 708 11–20 years # 71 69 143 432 715% 4 4 18 74 100 % 10 10 20 60 100


Note: — indicates no responses in the category. Note: — indicates no responses in the category.Chi-square value = 40.819 p<0.0001 Chi-square value = 30.989 p<0.002


have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing

anticipated TotalLess than 2 years # – 1 4 41 46 Less than 2 years # – 1 3 42 46

% – 2 9 89 100 % – 2 7 91 100

2–5 years # 3 9 22 192 226 2–5 years # 2 9 41 175 227% 1 4 10 85 100 % 1 4 18 77 100

6–10 years # 2 6 33 322 363 6–10 years # 3 13 59 290 365% 1 2 9 89 100 % 1 4 16 79 100

11–20 years # 6 6 61 637 710 11–20 years # 7 9 121 577 714% 1 1 9 90 100 % 1 1 17 81 100

Chi-square value = 19.789 p<0.345 # 8 13 52 1,014 1,087 More than 20 years # 7 20 84 981 1,092% 1 1 5 93 100 % 1 2 8 90 100







Table B-79. Actions regarding liability by physician licensure32. What is your primary specialty?46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following actions.


have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing

anticipated TotalLess than 2 years # – 1 1 44 46 Less than 2 years # – – 1 45 46

% – 2 2 96 100 % – – 2 98 100

2–5 years # 2 4 16 201 223 2–5 years # – 3 11 212 226% 1 2 7 90 100 % – 1 5 94 100

6–10 years # – 9 33 322 364 6–10 years # – 4 30 328 362% – 2 9 88 100 % – 1 8 91 100#

11–20 years # 7 9 84 614 714 11–20 years # 2 14 97 601 714% 1 1 12 86 100 % 0 2 14 84 100




have doneDefinitely

will do

May consider

doingNothing

anticipated TotalLess than 2 years # 2 4 7 33 46

% 4 9 15 72 100

2–5 years # 17 11 34 162 224% 8 5 15 72 100

6–10 years # 34 24 53 249 360% 9 7 15 69 100

11–20 years # 54 47 103 508 712% 8 7 14 71 100

More than 20 years # 89 65 113 822 1,089% 8 6 10 75 100






Table B-80. Actions regarding liability by practice location32. What is your primary specialty?

Practice locationAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated Total Practice locationAlready

have doneDefinitely

will do

May consider

doingNothing

anticipated TotalPortland Metro # 6 20 83 740 849 Portland Metro # 71 36 140 578 825

% 1 2 10 87 100 % 9 4 17 70 100

Mid-Willamette Valley # 1 12 41 363 417 Mid-Willamette Valley # 17 12 68 301 398% 0 3 10 87 100 % 4 3 17 76 100

Northwestern # – 2 9 35 46 Northwestern # 5 5 7 30 47% – 4 20 76 100 % 11 11 15 64 100

Southern # 2 4 23 174 203 Southern # 16 10 37 135 198% 1 2 11 86 100 % 8 5 19 68 100

Eastern # – 2 9 62 73 Eastern # 8 6 13 45 72% – 3 12 85 100 % 11 8 18 63 100

Southwestern # – – 5 35 40 Southwestern # 4 2 9 26 41% – – 13 88 100 % 10 5 22 63 100

Central # 2 3 19 142 166 Central # 12 8 38 107 165% 1 2 11 86 100 % 7 5 23 65 100

Note: — indicates no responses in the category. Chi-square value = 24.636 p<0.135Chi-square value = 11.512 p<0.871


Stop all direct patient care Stop services to specific groups



Table B-80. Actions regarding liability by practice location32. What is your primary specialty?46. Considering your concerns regarding liability—including the cost or availability of insurance coverage—please indicate whether you have taken or anticipate taking the following actions.


have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 8 5 13 74 100 % 2 2 6 91 100


Northwestern # 7 2 5 32 46 Northwestern # 1 2 3 37 43% 15 4 11 70 100 % 2 5 7 86 100


Eastern # 8 3 18 44 73 Eastern # – 1 7 63 71% 11 4 25 60 100 % – 1 10 89 100

Southwestern # 5 5 6 26 42 Southwestern # – – 1 39 40% 12 12 14 62 100 % – – 3 98 100

Central # 14 15 25 111 165 Central # 1 2 8 144 155% 8 9 15 67 100 % 1 1 5 93 100

Chi-square value = 30.735 p<0.031 Note: — indicates no responses in the category.Chi-square value = 14.469 p<0.698






have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 6 5 16 74 100 % 10 12 18 61 100




Eastern # 5 3 13 52 73 Eastern # 13 10 21 30 74% 7 4 18 71 100 % 18 14 28 41 100

Southwestern # 2 3 6 32 43 Southwestern # 9 2 8 24 43% 5 7 14 74 100 % 21 5 19 56 100

Central # 11 12 27 115 165 Central # 15 28 40 85 168% 7 7 16 70 100 % 9 17 24 51 100


Reduce patient care hours Increase referral of complex cases





have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 1 1 6 92 100 % 0 2 10 88 100



Southern # – 5 19 181 205 Southern # 1 3 30 170 204% – 2 9 88 100 % 0 1 15 83 100

Eastern # – 1 15 58 74 Eastern # – 1 20 52 73% – 1 20 78 100 % – 1 27 71 100

Southwestern # – – 4 39 43 Southwestern # – 1 8 34 43% – – 9 91 100 % – 2 19 79 100

Central # 1 1 14 150 166 Central # 3 6 23 136 168% 1 1 8 90 100 % 2 4 14 81 100







have doneDefinitely

will do

May consider

doingNothing


have doneDefinitely

will do

May consider

doingNothing


% 2 2 10 87 100 % 1 4 17 78 100


Northwestern # – 4 8 36 48 Northwestern # – 7 8 34 49% – 8 17 75 100 % – 14 16 69 100


Eastern # – 4 16 53 73 Eastern # – 4 12 55 71% – 5 22 73 100 % – 6 17 77 100

Southwestern # – 2 8 33 43 Southwestern # – 2 7 34 43% – 5 19 77 100 % – 5 16 79 100

Central # 2 11 21 134 168 Central # 2 12 34 121 169% 1 7 13 80 100 % 1 7 20 72 100







have doneDefinitely

will do

May consider

doingNothing

anticipated TotalPortland Metro # 67 57 103 614 841

% 8 7 12 73 100


Northwestern # 4 5 4 34 47% 9 11 9 72 100

Southern # 13 16 22 152 203% 6 8 11 75 100

Eastern # 4 6 13 50 73% 5 8 18 68 100

Southwestern # 5 2 4 32 43% 12 5 9 74 100

Central # 12 9 26 119 166% 7 5 16 72 100





Appendix A. Data comparison and categorization tables

Demographic characteristics Survey sampleBME 2004

census dataGender

Male 73 73Female 27 27

RegionPortland metropolitan 45 50Northwestern 6 5Mid-Willamette valley 23 21Southwestern 15 14Central 7 7Eastern 4 3

AgeUnder 40 20 2440–49 28 2850–59 33 2960–69 16 1370 and older 4 6

Table A-1. Demographic characteristics for comparison between 2004 Oregon Physician Workforce Survey sample and Oregon Board of Medical Examiners 2004 census data

Percentage



Table A-2. Oregon regions and counties within each region

Region CountiesPortland metropolitan Washington, Multnomah, Clackamas, Yamhill Mid-Willamette valley Linn, Benton, Marion, Polk, Lane Northwestern Clatsop, Tillamook, Columbia, Lincoln Southern Jackson, Douglas, Josephine Eastern Baker, Umatilla, Morrow, Grant, Wallowa, Union, Malheur, HarneySouthwestern Coos, Curry Central Jefferson, Crook, Deschutes, Lake, Klamath, Hood River, Wasco,

Sherman, Gilliam, Wheeler




Unique physician specialty Major specialty groupAdolescent medicine Primary careBehavioral pediatrics Primary careClinical & laboratory immunology Primary careDevelopmental behavioral pediatrics Primary careFamily practice Primary carePortland metropolitan Primary careGeneral practice Primary careMid-Willamette valley Primary careSouthwestern Primary careHospice Primary careHouse calls Primary careInternal medicine Primary careLactation Primary careObstetrics Primary careObstetrics-gynecology Primary carePediatric sports medicine Primary carePediatrics Primary carePreventive medicine Primary carePrimary care Primary careUrgent care Primary careAllergy & immunology Medical specialtyBone densitometry Medical specialtyBroncho-esophagology Medical specialtyCardiac electrophysiology Medical specialtyCardiology Medical specialtyCardiovascular disease Medical specialtyCerebrovascular disease Medical specialtyChild neurology Medical specialtyChronic wound care Medical specialtyClinical hypertension Medical specialtyClinical neurophysiology Medical specialtyConservative care of the spine Medical specialtyCornea & external disease Medical specialtyCritical care medicine Medical specialtyCystic fibrosis Medical specialtyDermatological immunology Medical specialtyDermatology Medical specialtyDermatopathology Medical specialtyDiabetes Medical specialtyDiabetic foot care Medical specialtyElectrodiagnosis neuro Medical specialtyElectrophysiology neuro Medical specialtyEndocardiography Medical specialtyEndocrinology & metabolism Medical specialtyEpilepsy neuro Medical specialtyGastroenterology Medical specialtyGlaucoma Medical specialtyGynecologic oncology Medical specialty




Unique physician specialty Major specialty groupHematology Medical specialtyHematology-oncology Medical specialtyHepatitis C Medical specialtyImmunohistocompatibility Medical specialtyInfectious disease Medical specialtyInfertility Medical specialtyInterventional cardiology Medical specialtyLaryngology Medical specialtyLipid metabolism Medical specialtyMaternal fetal medicine Medical specialtyMedical oncology Medical specialtyMedicine Medical specialtyMovement disorders Medical specialtyMultiple sclerosis Medical specialtyNeonatal-perinatal medicine Medical specialtyNeoplastic disease Medical specialtyNephrology Medical specialtyNeuro muscular Medical specialtyNeurodevelopmental disabilities Medical specialtyNeuroimmunology Medical specialtyNeurology Medical specialtyNeurology oncology Medical specialtyNeuromuscular disease Medical specialtyNon-invasive cardiology Medical specialtyNuclear cardiology Medical specialtyNuclear medicine Medical specialtyNutrition Medical specialtyOncology Medical specialtyOphthalmolic oncology Medical specialtyOphthalmology Medical specialtyOrthopaedic oncology Medical specialtyOsteopathic manipulative medicine Medical specialtyOsteoporosis Medical specialtyOtolaryngology Medical specialtyOtology-neurotology Medical specialtyPain management Medical specialtyPalliative medicine Medical specialtyPediatric allergy Medical specialtyPediatric cardiology Medical specialtyPediatric endocrinology Medical specialtyPediatric gastroenterology Medical specialtyPediatric hematology-oncology Medical specialtyPediatric infectious disease Medical specialtyPediatric internal medicine Medical specialtyPediatric nephrology Medical specialtyPediatric neurology Medical specialtyPediatric oncology Medical specialtyPediatric pulmonology Medical specialtyPediatric rheumatology Medical specialty




Unique physician specialty Major specialty groupPhlebology-vein care Medical specialtyPhysical medicine & rehabiliation Medical specialtyPreventative cardiology Medical specialtyPulmonary Medical specialtyPulmonary critical care Medical specialtyPulmonary disease Medical specialtyPulmonology Medical specialtyReproductive endocrinology Medical specialtyRespiratory disease Medical specialtyRetina Medical specialtyRheumatology Medical specialtySkin cancer Medical specialtySleep medicine Medical specialtySomnology Medical specialtySpinal cord injury medicine Medical specialtySports medicine Medical specialtyStroke Medical specialtyThoracic oncology Medical specialtyUrinary incontinence Medical specialtyUrogynecology Medical specialtyUrologic oncology Medical specialtyUrology Medical specialtyVascular medicine Medical specialtyVitreoretinal disease Medical specialtyWeight control Medical specialtyAbdominal surgery Surgical specialtyAdult reconstructive orthopedics Surgical specialtyArthroscopy Surgical specialtyBariatric surgery Surgical specialtyBreast surgery Surgical specialtyBurn surgery Surgical specialtyCancer surgery Surgical specialtyCardiothoracic surgery Surgical specialtyCardiovascular surgery Surgical specialtyCataract Surgical specialtyCataract Surgical specialtyColon & rectal surgery-proctology Surgical specialtyCornea & refractive surgery Surgical specialtyCosmetic medicine Surgical specialtyCraniofacial surgery Surgical specialtyCritical care surgery Surgical specialtyDermatologic surgery Surgical specialtyElectrosurgeon Surgical specialtyEndoscopy Surgical specialtyFoot & ankle orthopedics Surgical specialtyForensic otolaryngology Surgical specialtyGeneral surgery Surgical specialtyHand surgery Surgical specialtyHead & neck surgery Surgical specialty




Unique physician specialty Major specialty groupHip & knee replacement Surgical specialtyJoint replacement Surgical specialtyKnee Surgical specialtyLaparoscopic surgery Surgical specialtyLower extremity reconstructure Surgical specialtyMaxillofacial surgery Surgical specialtyMicrographic surgery Surgical specialtyNeuro ophthalmology Surgical specialtyNeurological surgery Surgical specialtyOculoplastics Surgical specialtyOral & maxillofacial surgery Surgical specialtyOral surgery Surgical specialtyOrbital Surgical specialtyOrthopedic surgery Surgical specialtyOrthopedic trauma Surgical specialtyPediatric cardiothoracic surgery Surgical specialtyPediatric maxillofacial surgery Surgical specialtyPediatric neurosurgery Surgical specialtyPediatric ophthalmology Surgical specialtyPediatric orthopedics Surgical specialtyPediatric otolaryngology Surgical specialtyPediatric surgery Surgical specialtyPediatric urology Surgical specialtyPelvic floor reconstruction Surgical specialtyPeripheral vascular Surgical specialtyPlastic surgery Surgical specialtyPlastic surgery-facial Surgical specialtyPulmonary surgery Surgical specialtyReconstructive surgery Surgical specialtyRefractive surgery Surgical specialtyRenal transplant Surgical specialtyRhinology Surgical specialtyShoulder & knee Surgical specialtyShoulder/elbow Surgical specialtyShoulders, hip & knee Surgical specialtySpine deformity Surgical specialtySpine surgery Surgical specialtyStrabismus Surgical specialtySurgical assisting Surgical specialtySurgical critical care Surgical specialtySurgical oncology Surgical specialtyThoracic surgery Surgical specialtyTransplant surgery Surgical specialtyTrauma surgery Surgical specialtyVascular surgery Surgical specialtyVitreoretinal surgery Surgical specialtyAnatomical pathology Hospital-basedAnesthesiology Hospital-basedBody imaging Hospital-based




Unique physician specialty Major specialty groupBreast imaging Hospital-basedCardiac anesthesia Hospital-basedChemical pathology Hospital-basedClinical pathology Hospital-basedCytopathology Hospital-basedDiagnostic radiology Hospital-basedEmergency medicine Hospital-basedForensic pathology Hospital-basedHematopathology Hospital-basedHospitalist Hospital-basedImmunopathology Hospital-basedIntensive care Hospital-basedInterventional radiology Hospital-basedMammography Hospital-basedMaxillofacial radiology Hospital-basedMRI Hospital-basedMusculoskeletal radiology Hospital-basedNeuroanesthesia Hospital-basedNeurointerventional radiology Hospital-basedNeuropathology Hospital-basedNeuroradiology Hospital-basedNuclear radiology Hospital-basedOB anesthesia Hospital-basedOBGYN pathology Hospital-basedPathologic anatomy Hospital-basedPathology Hospital-basedPediatric anesthesiology Hospital-basedPediatric critical care Hospital-basedPediatric emergency medicine Hospital-basedPediatric pathology Hospital-basedPediatric radiology Hospital-basedRadiation anesthesiology Hospital-basedRadiation oncology Hospital-basedRadioisotopic pathology Hospital-basedRadiological physics Hospital-basedRadiology Hospital-basedRadiology diagnostic Hospital-basedRadiology oncology Hospital-basedRenal pathology Hospital-basedSurgical pathology Hospital-basedTherapeutic radiology Hospital-basedUnderseas medicine Hospital-basedVascular & interventional radiology Hospital-basedWomen's imaging Hospital-basedAcupuncture OtherAddiction medicine OtherAddiction psychiatry OtherADHD OtherAdministrative medicine Other




Unique physician specialty Major specialty groupAdolescent psychiatry OtherAerospace medicine OtherAlternative OtherAnxiety disorders OtherAviation medicine OtherBlood banking-transfusion medicine OtherChild & adolescent psychiatry OtherChild abuse OtherChild psychiatry OtherChiropractic OtherClinical biochemical genetics OtherClinical biochemical-molecular genetics OtherClinical cytogenics genetics OtherClinical genetics OtherClinical molecular genetics OtherCommunity psychiatry OtherConsulting pyschiatry OtherCorrectional medicine OtherDialysis access OtherDisability determination OtherDNA OtherEpidemiology OtherFeeding disorders OtherForensic psychiatry OtherGeriatric psychiatry OtherHistopath OtherHolistic medicine OtherIndependent medical evaluations OtherIndustrial medicine OtherIntegrative medicine OtherLegal medicine OtherManipulation OtherMedical ethics OtherMedical genetics OtherMedical informatics OtherMedical microbiology OtherMedical research OtherMedical toxicology OtherNeuropsychiatry OtherOccupational medicine OtherOther OtherPharmacology OtherPsychiatry OtherPsychiatry-adult OtherPsychoanalysis OtherPsychoanalysis-adult OtherPsychoanalysis-child OtherPsychoanalytic therapy Other




Unique physician specialty Major specialty groupPsychopharmacology OtherPsychosomatic medicine OtherPsychotherapy OtherPublic health OtherQuality improvement OtherStress management OtherTransfusion medicine OtherTropical/travel medicine Other



Appendix C. 2004 Oregon Physician Workforce Survey instrument

- 1 -

2004 Oregon Physician Workforce Survey IMPORTANT—Please return by September 10, 2004.

SURVEY INSTRUCTIONS

Check here if your professional time DOES NOT involve any direct patient care or any administration in Oregon and do NOT complete the survey. Please return the survey in the enclosed business reply envelope addressed to Oregon Physician Workforce Survey Research Group.

Please mark your answers with an “X.” You may be directed to skip questions in the survey. If you must

skip questions, you will see an arrow with a note indicating which question to answer next, like this: 1 Yes GO TO QUESTION #3 2 No

We recognize that you may not practice exclusively in Oregon. However, please answer the questions with regard to your professional duties in Oregon only.

ABOUT YOU 1. What is your gender? 1 Female 2 Male

2. What is your age group? 1 Under 40 years

2 40–49 years 3 50–59 years 4 60–69 years 5 70 years and over

3. Are you Hispanic or Latino? 1 Yes 2 No

4. What is your race? Select all that apply. 1 White 1 Black or African American 1 Asian

1 Native Hawaiian or Pacific Islander 1 American Indian or Alaskan Native 1 Other (specify) ______________________________

5. In addition to English, in which languages can you communicate effectively for most clinical purposes? Select all that apply.

1 Russian 1 Spanish 1 Vietnamese 1 Other (specify) ______________________________

6. How long have you had a medical license in any state, including Oregon? Select only one. 1 Less than 2 years 2 2–5 years 3 6–10 years 4 11–20 years 5 More than 20 years

7. When do you plan to retire? Select only one. 1 Within the next 2 years 2 In the next 2 to 5 years 3 More than 5 years from now

8. What is your practice or employment status in Oregon? Select all that apply. 1 Clinical practice 1 Teaching 1 Research 1 Administration, not related to direct patient care 1 Resident/Fellow 1 Retired 1 Not practicing or not employed in medical field 1 Other (specify) __________________________

9. How satisfied have you been with your medical career in the last 12 months? Select only one. 1 Very satisfied 2 Somewhat satisfied 3 Neither satisfied nor dissatisfied 4 Somewhat dissatisfied 5 Very dissatisfied

10. How satisfied are you with your medical career overall? Select only one. 1 Very satisfied 2 Somewhat satisfied 3 Neither satisfied nor dissatisfied 4 Somewhat dissatisfied 5 Very dissatisfied

11. What is the greatest source of your professional satisfaction? Select only one. 1 Income 2 Intellectual challenge 3 Patient relationships 4 Practice environment 5 Other (specify) ______________________________________________

______________________________________________

- 2 -

ABOUT YOUR PRACTICE

The following questions are related to practice administration and payer mix. Your clinic or office administrator may provide assistance with questions #12–23.

12. Estimate the percentage of patients in your practice by lines of business in the last 12 months. The total should equal 100%.

Commercial insurance %

Medicare %

Medicaid/Oregon Health Plan (OHP) fee-for-service %

Medicaid/Oregon Health Plan (OHP) managed care %

TRICARE/CHAMPUS %

Workers’ Compensation %

Uninsured %

TOTAL (should equal 100%) 100 %

13. Does your practice have a discounted fee schedule? 1 Yes 2 No 3 Don’t know

14. How many calendar days are normally required to schedule a non-urgent appointment for both new and established patients? _______ Days for new patients

_______ Days for established patients _______ Not applicable _______ Don’t know

15. For each of the payers listed below, please indicate whether your office accepts all, limits acceptance, or accepts none of the following:

Accept all Limit acceptance

Year limited acceptance Accept none Year stopped

acceptance Commercial insurance 1 2 ________ 3 ________ Medicare 1 2 ________ 3 ________ Medicaid/OHP fee-for-service 1 2 ________ 3 ________ Medicaid/OHP managed care 1 2 ________ 3 ________ TRICARE/CHAMPUS 1 2 ________ 3 ________ Workers’ Compensation 1 2 ________ 3 ________ Uninsured 1 2 ________ 3 ________

- 3 -

16. If you accept all lines of business GO TO QUESTION #17. For each of the lines of business in which you limit or DO NOT accept patients, please indicate the importance of each factor on your decision to restrict or close your practice.

Please answer using a scale of 1 to 3, in which 1=Not important, 2=Somewhat important, 3=Very important, or NA= Not applicable.

Rank: 1=Not important, 2=Somewhat important, 3=Very important, or NA= Not applicable

Commercial insurance Medicare

Medicaid/OHP fee-for-service

Medicaid/OHP managed care

Workers’ Compensation

Example: Practice is full 2 1 3 2 NA

Balanced payer source

_____

_____

_____

_____

_____

Cost of translation services

_____

_____

_____

_____

_____

Increasing overhead costs

_____

_____

_____

_____

_____ Cost or availability of professional liability insurance

_____

_____

_____

_____

_____

Practice is full

_____

_____

_____

_____

_____

Non-compliant patients

_____

_____

_____

_____

_____

Complex clinical needs of patients

_____

_____

_____

_____

_____

Complex social needs of patients

_____

_____

_____

_____

_____

Administrative requirements

_____

_____

_____

_____

_____

Reimbursement rates

_____

_____

_____

_____

_____

HMO left market

_____

_____

_____

_____

NA

Changes in health benefit packages _____ _____ _____ _____ _____ 17. Please indicate whether you anticipate taking the following actions in your practice in the next two years?

Select one in each row.

Definitely will do Might do Not anticipated Not applicable

Stop providing all direct patient care 1 2 3 4 Stop providing services to specific groups of patients (specify)______________________________________

1 2 3 4 Stop providing certain services (specify services) _____________________________________________ 1 2 3 4 Start providing certain services (specify services) _____________________________________________ 1 2 3 4 Reduce patient care hours 1 2 3 4 Increase referral of complex cases 1 2 3 4 Relocate practice within state 1 2 3 4 Relocate practice to another state 1 2 3 4 Close or sell practice 1 2 3 4 Retire from practice 1 2 3 4 Increase diagnostic procedures performed 1 2 3 4

- 4 -

18. What percentage of your patients do you or your office staff help to enroll in pharmaceutical assistance programs? Select only one. 1 Zero (specify why) __________________________

_______________________ GO TO QUESTION #20 2 Up to 10% 3 11-25% 4 26-50% 5 51-75% 6 76-100% 7 Don’t know

19. For those patients whom your practice helps enroll, how much time do you or your staff spend per patient? Select only one.

1 15 minutes or less 2 16 to 30 minutes 3 31 to 60 minutes 4 More than 60 minutes 5 Don’t know

20. Did your practice ask Medicaid/OHP patients to make their co-payments prior to July 1, 2004?

1 Not applicable 2 Yes 3 Sometimes 4 No 5 Don’t know

21. Is your office staff aware of the OHP Provider Services line, a telephonic resource for general Medicaid and billing/claims questions?

1 Yes 2 No GO TO QUESTION #24 3 Don’t know GO TO QUESTION #24

22. Has your office staff used the OHP Provider Services line? 1 Yes 2 No GO TO QUESTION #24 3 Don’t know GO TO QUESTION #24

23. How satisfied was your office staff with its last interaction with the OHP Provider Services line? 1 Very satisfied 2 Somewhat satisfied 3 Neither satisfied nor dissatisfied 4 Somewhat dissatisfied 5 Very dissatisfied 6 Don’t know

Only the physician should answer the remainder of the questions in this survey.

24. Are you aware of the Oregon Tobacco Quit Line? 1 Yes

2 No GO TO QUESTION #27

25. Have you ever referred patients to the Oregon Tobacco Quit Line?

1 Yes 2 No

26. To the best of your knowledge does the Oregon Health Plan cover smoking cessation treatments? 1 Yes 2 No 3 Don’t know

27. Do you have concerns regarding providing care to Medicaid/OHP patients?

1 Yes 2 No GO TO QUESTION #29 28. What is your greatest concern about providing care to

Medicaid/OHP patients? ______________________________________________

______________________________________________

______________________________________________

29. What is the size of your primary practice, that is, the practice in which you spend the most time?

Select only one. 1 Solo practice 2 Small group practice (2–4 physicians) 3 Medium group practice (5–9 physicians) 4 Large group practice (10 or more physicians)

Specify number of physicians __________

30. In a typical week, how many hours do you spend on call? Select only one.

1 No on-call hours 2 1–10 hours/week 3 11–20 hours/week 4 21–30 hours/week 5 More than 30 hours/week 6 Always on call 31. In the last 12 months, have you changed your hospital

privileges for any of the following reasons? Select all that apply. 1 Haven’t changed 1 Required procedures beyond the scope of practice

1 Increased demand for call coverage 1 Change in practice 1 Change in hospital bylaws 1 Increased uncompensated care 1 Other reason (specify) _________________________

___________________________________________

- 5 -

32. What is your primary specialty? If applicable, what are your other specialties? List all that apply.

Primary specialty ____________________________________________________

Other specialties ____________________________________________________

33. For your primary practice location (the location at which you spend the greatest amount of time in direct patient care), please complete the following:

33a. Number of hours per week in direct patient care, by specialty. For number of hours per week, INCLUDE time spent on patient record keeping, patient-related office work, and travel time connected with seeing patients. EXCLUDE training, teaching or research time, hours on call when not actually working, and travel time between home and work. Primary specialty ____________ hours/week Other specialties ____________ hours/week

33b. Setting and ownership Select all that apply. 33c. Employment Select only one.

1 Hospital ZIP Code__________ 1 Clinic/Office – Private, for profit ZIP Code__________ 1 Clinic/Office – Private, not for profit ZIP Code__________ 1 Clinic/Office – Public ZIP Code__________ 1 Other (specify) _________________ ZIP Code__________

1 A full or part owner of the practice 2 An employee of the practice or health system 3 An independent contractor 4 A volunteer—no ownership/employment 5 Other (specify)______________________________

34. For your secondary practice location (the location at which you spend the second greatest amount of time), please complete the following:

1 Does not apply. No secondary practice location. GO TO QUESTION #35

34a. Number of hours per week in direct patient care, by specialty. For number of hours per week, INCLUDE time spent on patient record keeping, patient-related office work, and travel time connected with seeing patients. EXCLUDE training, teaching or research time, hours on call when not actually working, and travel time between home and work. Primary specialty ____________ hours/week Other specialties ____________ hours/week

34b. Setting and ownership Select all that apply. 34c. Employment Select only one.

1 Hospital ZIP Code__________ 1 Clinic/Office – Private, for profit ZIP Code__________ 1 Clinic/Office – Private, not for profit ZIP Code__________ 1 Clinic/Office – Public ZIP Code__________ 1 Other (specify) _________________ ZIP Code__________

1 A full or part owner of the practice 2 An employee of the practice or health system 3 An independent contractor 4 A volunteer—no ownership/employment 5 Other (specify)______________________________

35. In a typical week, how many new and established

patients do you see? Please provide your best estimate.

______ New patients seen in a typical week

______ Established patients seen in a typical week _____ Not applicable

36. In a typical week, how many hours do you spend doing administrative tasks related to direct inpatient and outpatient care (e.g., charting, phone calls, referrals, paperwork, etc.)? Please provide your best estimate.

______ Hours in a typical week doing administrative tasks

37. If you are a neurosurgeon, please answer 37a and 37b. All others GO TO QUESTION #38

37a. Are you currently performing brain surgery? 1 Yes 2 No

37b. Are you currently performing spine surgery? 1 Yes 2 No

- 6 -

38. If you have practiced, or currently practice, maternity care, please answer #38a. All others GO TO QUESTION #39.

38a. Are you currently delivering babies? 1 Yes

2 No GO TO QUESTION #38d

38b. Does your maternity care practice include the following procedures? For each of the procedures you perform, please indicate how many you have performed in the last 12 months. Please provide your best estimate.

Do perform Number in last 12

months Do not perform

High-risk pregnancies and/or deliveries 1 ______ 2 VBAC 1 ______ 2 Deliveries for Medicaid women 1 ______ 2 Assisting in cesarean sections 1 ______ 2 Performing cesarean sections as the primary surgeon 1 ______ 2

Number of all deliveries in the last 12 months __________________ 38c. In the next year, do you plan to stop delivering? All babies?

1 Yes GO TO QUESTION #39 2 No

Babies for Medicaid patients? 1 Yes GO TO QUESTION #39 2 No GO TO QUESTION #39

38d. How long ago did you stop delivering babies? Select only one. 1 Within the last year 2 1 to 2 years ago 3 More than 2 years ago

38e. Please rate the importance of each of the following factors in your decision to stop delivering babies. Select only one in each row.

Factors Very important

Somewhat important

Not important

Not applicable

Lack of backup coverage for cesarean sections 1 2 3 4 Time demands/personal life 1 2 3 4 Medical liability premiums 1 2 3 4 Experience with lawsuit(s) 1 2 3 4 Lack of demand 1 2 3 4 Low level of reimbursement 1 2 3 4 Lack of interest 1 2 3 4 Hospital privilege issues 1 2 3 4 Other (specify)____________________________ 1 2 3 4

- 7 -

ABOUT YOUR PROFESSION 39. Rate the importance of each of the following issues to you. Select only one in each row.

Very Important

Somewhat Important

Not Important

Electronic medical records 1 2 3 Medicare reimbursement 1 2 3 Cost of doing business/overhead 1 2 3 Pharmaceutical costs 1 2 3 Stress and burnout 1 2 3 Cost/availability of professional liability insurance 1 2 3 Call coverage 1 2 3 Cost of translation services 1 2 3 Coverage for the uninsured 1 2 3 Medicaid/OHP reimbursement 1 2 3 Commercial insurance reimbursement 1 2 3 Recruitment of qualified non-physician staff 1 2 3 Providing culturally and linguistically appropriate services 1 2 3 Recruitment of physicians 1 2 3 Health plan timeliness of payment 1 2 3 Medicare prescription drug benefit 1 2 3 Patient safety 1 2 3 Electronic prescribing 1 2 3 Government regulation and oversight 1 2 3 Hospital/medical staff issues 1 2 3 Retention of physicians 1 2 3

40. Are you currently covered by professional medical

liability insurance? 1 Yes 2 No (specify why not)__________________________

________________________ GO TO QUESTION #45

41. What is the source of your professional liability coverage? Select all that apply. 1 Commercial insurance company 1 Self-insured 1 State or Federal Tort Claims Act 1 Other (specify) 1 Don’t know

42. What is the form of your professional liability coverage? Select all that apply.

1 Occurrence coverage 1 Claims-made coverage 1 State or Federal Tort Claims Act 1 Don’t know

43. What is the amount of your current basic professional liability coverage? Select only one. 1 Not applicable, State or Federal Tort Claims Act 2 $1,000,000 per claim; $3,000,000 aggregate 3 $2,000,000 per claim; $4,000,000 aggregate 4 $3,000,000 per claim; $3,000,000 aggregate 5 $5,000,000 per claim; $5,000,000 aggregate 6 Other (specify) $____________per claim; $____________aggregate 7 Don’t know

44. What is the annual premium amount for professional liability insurance that you are paying today?

$

1 Don’t know

45. If you changed sources for professional liability insurance within the last three years, what was the principal reason for your change? Select only one. 1 Not applicable, have not changed 2 Rate increase 3 Change of practice setting/employment 4 Insurance company withdrew from market 5 Insurance company did not renew coverage 6 Other (specify)_______________________________

- 8 -


Already have done

Definitely will do

May consider

doing

Nothing anticipated

Stop providing all direct patient care 1 2 3 4 Stop providing services to specific groups of patients (specify)

________________________________________________________ 1 2 3 4

Stop providing certain services (specify services)

________________________________________________________ 1 2 3 4

Start providing certain services (specify services)

________________________________________________________ 1 2 3 4

Reduce patient care hours 1 2 3 4 Increase referral of complex cases 1 2 3 4 Relocate practice within state 1 2 3 4 Relocate practice to another state 1 2 3 4 Close or sell practice 1 2 3 4 Retire from practice 1 2 3 4 Increase diagnostic procedures performed 1 2 3 4

47. The Medicare Prescription Drug, Improvement, and

Modernization Act of 2003 appropriated a 1.5 percent increase for physician reimbursements in 2004 and 2005. Did you change your practice as a result of this provision? 1 Yes 2 No GO TO QUESTION #49 3 Do not see Medicare patients GO TO QUESTION #50

48. Which of the following describes the changes in practice you made as a result of this legislation? Select only one. 1 Limited acceptance of new Medicare patients 2 Decided not to accept new Medicare patients 3 Dropped all Medicare patients

49. If Medicare reimbursement for physicians declines in 2006, which of the following actions will you take?

Select only one. 1 Will accept all new Medicare patients 2 Will limit acceptance of new Medicare patients 3 Will not accept new Medicare patients 4 Will drop all Medicare patients 5 Undecided

50. What is the greatest challenge you will face professionally in the next two years? ______________________________________________

______________________________________________

______________________________________________

51. Please provide any other comments you wish to make

regarding your practice. Attach an additional sheet as necessary. ______________________________________________

______________________________________________

______________________________________________

Thank you for your participation. Please place the survey in the business reply envelope addressed to Oregon Physician Workforce Survey Research Group.

IMPORTANT—Please return the completed survey by September 10, 2004.

Prepared by OMPRO under contract no. 105570 OMAP-EQRO-OR-05-01.1

2004 Oregon Physician Workforce Survey Report of Results · 2017-04-20 · 2004 Oregon Physician...

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